NPIMap

Organization Active NPI

CS Medical Associates, P.C.

  • Counselor
  • Amityville, NY
National Provider Identifier
1790653236
Registry record updated Oct 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
CS MEDICAL ASSOCIATES, P.C.
Practice address
64 Broadway
Amityville, NY 11701-2702
Phone
(631) 696-4357
NPI assigned
Oct 27, 2025
Last updated
Oct 27, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CS MEDICAL ASSOCIATES, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracey Wallace
Title
VP Ops
Phone
(631) 696-4357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X Primary

Addresses

Primary practice location

64 Broadway
Amityville, NY 11701-2702

Mailing address

1377 Motor Pkwy Ste 102
Islandia, NY 11749-5249

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180329000208 NY Part B Supplier - Clinic/Group Practice 9335401454 Receives reassigned benefits from 95 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hempstead, NY; Shirley, NY; Port Jefferson, NY; Massapequa Park, NY; Hicksville, NY; Farmingville, NY; Amityville, NY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2341408CS Medical Associates PC64 Broadway, Amityville, NY 11701Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
CS Medical Associates PC9 organizations share this tax ID, including this one
Part of
CS Medical Associates PC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

120 Bethpage Rd
Ste 101
Hicksville, NY 11801

727 N Broadway
North Massapequa, NY 11758
Phone (516) 799-0210

1000 Main St
Ste 1S
Port Jefferson, NY 11777
Phone (631) 296-1113

2 Coraci Blvd
Ste 16
Shirley, NY 11967

Practitioners & affiliated clinicians

Practitioners 114

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 114

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1761523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761523200000",
    "number": "1790653236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY STE 102",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 BROADWAY",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012702",
            "telephone_number": "631-696-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CS MEDICAL ASSOCIATES, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CS MEDICAL ASSOCIATES, P.C.",
        "enumeration_date": "2025-10-27",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "VP OPS",
        "authorized_official_telephone_number": "631-696-4357"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Amityville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.