Organization Active NPI

Abc Medical PC

  • Internist Chiropractor
  • Astoria, NY
National Provider Identifier
1801093166
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internist ChiropractorTaxonomy code 111NI0900X
Legal business name
ABC MEDICAL PC
Practice address
2126 Broadway
Astoria, NY 11106-4533
Phone
(718) 932-1700
NPI assigned
Jun 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

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

Authorized official

Name
Rose Santana
Title
Medical Assistant
Phone
(718) 932-1700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internist ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NI0900X Primary

Addresses

Primary practice location

2126 Broadway
Astoria, NY 11106-4533

Mailing address

2126 Broadway
Astoria, NY 11106-4533

Other identifiers 1

IdentifierTypeStateIssuer
01134023MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120113000241 NY Part B Supplier - Clinic/Group Practice 5890962963 Receives reassigned benefits from 1 practitioner
Practice locations: Astoria, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1801093166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2126 BROADWAY",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111064533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2126 BROADWAY",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111064533",
            "telephone_number": "718-932-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABC MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-29",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A",
        "authorized_official_last_name": "SANTANA",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "MEDICAL ASSISTANT",
        "authorized_official_telephone_number": "718-932-1700"
    },
    "taxonomies": [
        {
            "code": "111NI0900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Internist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01134023",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; 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.

Verify at the official NPI Registry.