Active NPI
Bert Jeff Forman, MD
- Anesthesiology Physician
- Rockville Ctr, NY
National Provider Identifier
1811905847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 1481811
- Practice address
- 1000 N Village Ave
Mercy Medical Ctr
Rockville Ctr, NY 11570 - Phone
- (516) 705-1212
- NPI assigned
- Aug 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 1481811 | NY | Primary |
Addresses
Primary practice location
1000 N Village Ave
Mercy Medical Ctr
Rockville Ctr, NY 11570
Mailing address
PO Box 372
Baldwin, NY 11510
Phone (516) 763-4353
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00913873 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1481811 | NY | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811905847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 372",
"city": "BALDWIN",
"state": "NY",
"postal_code": "11510",
"telephone_number": "516-763-4353",
"fax_number": "516-763-1232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 N VILLAGE AVE",
"address_2": "MERCY MEDICAL CTR",
"city": "ROCKVILLE CTR",
"state": "NY",
"postal_code": "11570",
"telephone_number": "516-705-1212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMAN",
"first_name": "BERT",
"middle_name": "JEFF",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NY",
"license": "1481811",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00913873",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockville Ctr, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.