Active NPI
Ajs Brookyln Medical Practice PC
- Clinic/Center
- New York, NY
National Provider Identifier
1780040923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- AJS BROOKYLN MEDICAL PRACTICE PC
- Practice address
- 30 W 60TH St
Suite an
New York, NY 10023-7902 - Phone
- (718) 369-4850
- NPI assigned
- Jan 4, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Donna Stidham
- Title
- Chief, Managed Care
- Phone
- (323) 436-5025
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
30 W 60TH St
Suite an
New York, NY 10023-7902
Mailing address
6255 W Sunset Blvd FL 21
Los Angeles, CA 90028-7422
Phone (323) 860-5200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131029000201 | NY | Part B Supplier - Clinic/Group Practice | 5395970362 |
Receives reassigned benefits from 27 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bronx, NY; New York, NY; Jamaica, NY; Far Rockaway, NY; Brooklyn, NY |
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451865600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1568160000000",
"number": "1780040923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6255 W SUNSET BLVD FL 21",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900287422",
"telephone_number": "323-860-5200",
"fax_number": "833-241-7615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 W 60TH ST",
"address_2": "SUITE AN",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100237902",
"telephone_number": "718-369-4850"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AJS BROOKYLN MEDICAL PRACTICE PC",
"organizational_subpart": "NO",
"enumeration_date": "2016-01-04",
"last_updated": "2019-09-11",
"status": "A",
"authorized_official_last_name": "STIDHAM",
"authorized_official_first_name": "DONNA",
"authorized_official_title_or_position": "CHIEF, MANAGED CARE",
"authorized_official_telephone_number": "323-436-5025"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.