NPIMap

Organization Active NPI

Rd Medical Professional Services PC

  • Family Medicine Physician
  • Staten Island, NY
National Provider Identifier
1811643166
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RD MEDICAL PROFESSIONAL SERVICES PC
Practice address
260 Christopher LN Ste 102a
Staten Island, NY 10314-1631
Phone
(914) 295-9323
Fax
(315) 612-9793
NPI assigned
Feb 25, 2022
Last updated
Jan 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

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

Authorized official

Name
Camila Mendez
Title
Director of Operations
Phone
(914) 295-9323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

260 Christopher LN Ste 102a
Staten Island, NY 10314-1631

Mailing address

20980 Cipres Way
Boca Raton, FL 33433-1604
Phone (914) 295-9323

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY, FL, PA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20220317000374 NJ Part B Supplier - Clinic/Group Practice 8628463296 Receives reassigned benefits from 10 practitioners
Practice locations: Keansburg, NJ; West Milford, NJ; Wayne, NJ; Toms River, NJ; Paterson, NJ; Passaic, NJ; Newark, NJ; Montclair, NJ…
O20220325000700 NY Part B Supplier - Clinic/Group Practice 8628463296 Receives reassigned benefits from 48 practitioners
Practice locations: Bronx, NY; Brooklyn, NY; Freeport, NY; Holbrook, NY; Island Park, NY; New York, NY; Rockaway Park, NY; Syracuse, NY…
O20221213002155 FL Part B Supplier - Clinic/Group Practice 8628463296 Receives reassigned benefits from 19 practitioners
Practice locations: St Petersburg, FL; Sarasota, FL; Saint Petersburg, FL; Port Charlotte, FL; Kenneth City, FL; Pensacola, FL; Orange Park, FL; Orlando, FL…
O20250121000422 PA Part B Supplier - Clinic/Group Practice 8628463296 Receives reassigned benefits from 7 practitioners
Practice locations: Philadelphia, PA; Norristown, PA

National Provider Directory

National Provider Directory

Locations

21067 Powerline Rd 57
Boca Raton, FL 33433

32 Laurel Ave
Keansburg, NJ 07734
Phone (732) 787-8100

231 Warner St
#1028
Toms River, NJ 08755
Phone (973) 494-6262

140 Beach 114th St
Rockaway Park, NY 11694
Phone (718) 945-4600

612 Corporate Way
Ste 1M
Vly Cottage, NY 10989
Phone (718) 732-3634

9501 State Rd
Philadelphia, PA 19114
Phone (215) 632-5700

Practitioners & affiliated clinicians

Practitioners 89

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 89

NPI Registry JSON

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

{
    "created_epoch": "1645747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1811643166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20980 CIPRES WAY",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334331604",
            "telephone_number": "914-295-9323",
            "fax_number": "315-612-9793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 CHRISTOPHER LN STE 102A",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103141631",
            "telephone_number": "914-295-9323",
            "fax_number": "315-612-9793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RD MEDICAL PROFESSIONAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-25",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A",
        "authorized_official_last_name": "MENDEZ",
        "authorized_official_first_name": "CAMILA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "914-295-9323"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.