Rd Medical Professional Services PC
Organization Active NPI Family Medicine Physician · Staten Island, NY
NPI 1811643166 · NPPES record last updated Jan 2, 2024
Key facts
- NPI
- 1811643166
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 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
- Organization subpart
- No
Authorized official
- Name
- Camila Mendez
- Title
- Director of Operations
- Phone
- (914) 295-9323
Practitioners 89
-
Sofia Tofiga Gamidova, APN-C
-
Sara George, FNP
-
Claire Jacobs-Sims, FNP
-
Michele McDermott, N.P.
-
Vidya Meppurath, NP
-
Khemraj Mohan, NP
-
Stephany N Semexant, FNP-BC
-
Andrew Weissman, RPA-C
-
Wankisha Anneka Byars, APRN
-
Laura Crotty, APN
-
Martha Davault, ARNP
-
Maria Emilia Mejia, APRN, B.C.
-
Erica Peraino, CRNP
-
Janice B Rosenbaum, CRNP
-
Lisa Marie Smith-Hannon, APRN-C
-
Chelsey Smith, APRN
-
Alexandra Christine Summitt, D.N.P.
-
Cynthia Carlson, FNP
-
Joannie Pompee, PA-C
-
Musafau Oladiran Adenaike, PMHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in NJ, NY, FL, PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
231 Warner St
#1028
Toms River, NJ 08755
Phone (973) 494-6262
69 Maple Rd
West Milford, NJ 07480
Phone (973) 697-5640
260 Christopher Ln
Staten Island, NY 10314
Phone (718) 317-5522
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
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
Other providers in Staten Island, NY
- Melanie Raz
- Yael Raz
- Syed Ahsan Raza Sr.
- Syed Rashid Razi
- Adrianna Razzore
- Stacie L Re
- Shannon Rea
- Reach Potential LLC
- Reaching Higher Licensed Behavior Analyst PC
- Reactive Physical Therapy PC
All providers in Staten Island, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.