Individual provider Active NPI

Polina Gilchyonok, M.D.

  • Internal Medicine Physician
  • Larchmont, NY
National Provider Identifier
1790719615
Registry record updated Oct 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
196246 Issued in NY
Practice address
31 Prospect Ave
Larchmont, NY 10538
Phone
(914) 523-0451
Fax
(914) 630-7314
NPI assigned
Jul 10, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 196246 NY Primary

Addresses

Primary practice location

31 Prospect Ave
Larchmont, NY 10538

Mailing address

31 Prospect Ave
Larchmont, NY 10538
Phone (914) 523-0451

Other identifiers 1

IdentifierTypeStateIssuer
01507088MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061128000189 NY Practitioner - Internal Medicine 6901804061 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
196246NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York City Health and Hospitals Corporation Internal Medicine Current Accepting new patients
New York City Health and Hospitals Corporation Internal Medicine CurrentSince Jul 14, 2020 Accepting new patients
New York City Health and Hospitals Corporation CurrentSince Jul 14, 2020 Accepting new patients
New York City Health and Hospitals Corporation Internal Medicine Past Accepting new patients
Regional Physician Services, PC Internal Medicine PastSince Mar 10, 2009 Accepting new patients
Medical Network Services PC Internal Medicine Past Accepting new patients
Gramercy Park Medical PC Internal Medicine Past Accepting new patients

Locations

50 Water St
Fl 3
New York, NY 10004

227 Madison St
New York, NY 10002
Phone (212) 238-7000

460 Brielle Ave
Staten Island, NY 10314
Phone (646) 694-6680

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8825/brand/4/csg/1/fhir/r4

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413331200000",
    "number": "1790719615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 PROSPECT AVE",
            "city": "LARCHMONT",
            "state": "NY",
            "postal_code": "10538",
            "telephone_number": "914-523-0451",
            "fax_number": "914-630-7314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 PROSPECT AVE",
            "city": "LARCHMONT",
            "state": "NY",
            "postal_code": "10538",
            "telephone_number": "914-523-0451",
            "fax_number": "914-630-7314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILCHYONOK",
        "first_name": "POLINA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2014-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "196246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01507088",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Larchmont, NY

Sources for this page

Verify at the official NPI Registry.