Maryanne E Modrak, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

162487-1 Issued in NY

Practice address

507 Main St
Johnson City, NY 13790-1810

Phone

(607) 763-8008

Fax

(607) 763-8019

NPI assigned

Aug 24, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449619200000",
    "number": "1790778876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 LEWIS ROAD",
            "address_2": "2ND FLOOR",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139035227",
            "telephone_number": "607-729-8156",
            "fax_number": "607-729-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 MAIN ST",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137901810",
            "telephone_number": "607-763-8008",
            "fax_number": "607-763-8019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODRAK",
        "first_name": "MARYANNE",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-24",
        "last_updated": "2015-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "162487-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01025754",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McKenna Hope Miller, OTR/L
• William Miller, M.D.
• Seyedeh Mirrazavi
• Missih Dental Care & Periodontics LLC
• Nicole Mizera, NP
• Chitta R Mohapatra, MD
• Margaret Susan Monborne, OTR
• Jennifer Kathryn Monnin, PHARMD
• Julio Damian Montejo Jr., MD, MHS
• Vincent Montone, MD

• Internal Medicine Physician in Johnson City, NY
• Providers in Johnson City, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.