NPIMap

Organization Active NPI

Phase Two Podiatry PC

  • Podiatrist
  • Hewlett, NY
National Provider Identifier
1821333063
Registry record updated Feb 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
N005974 Issued in NY
Legal business name
PHASE TWO PODIATRY PC
Practice address
301 Mill Road
Suite U-7
Hewlett, NY 11557-2326
Phone
(516) 792-0070
Fax
(516) 706-6607
NPI assigned
Nov 28, 2012
Last updated
Feb 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2016

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

Authorized official

Name
Dr. Nachum Pelcovitz, DPMNPI 1619975943
Title
Ceo
Phone
(516) 792-0070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X N005974 NY Primary

Addresses

Primary practice location

301 Mill Road
Suite U-7
Hewlett, NY 11557-2326

Mailing address

301 Mill Road
Suite U-7
Hewlett, NY 11557-2326
Phone (516) 792-0070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ, MA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20130625000774 NY Part B Supplier - Clinic/Group Practice 2961641824 Receives reassigned benefits from 39 practitioners
Practice locations: Briarcliff Manor, NY; Far Rockaway, NY; Williamsville, NY
O20150908001025 NJ Part B Supplier - Clinic/Group Practice 2961641824 Receives reassigned benefits from 10 practitioners
Practice locations: West Milford, NJ
O20210512000762 MA Part B Supplier - Clinic/Group Practice 2961641824 Receives reassigned benefits from 2 practitioners
Practice locations: Amesbury, MA; Boston, MA

National Provider Directory

National Provider Directory

Locations

69 Maple Rd
#506
West Milford, NJ 07480
Phone (973) 697-5640

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1821333063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MILL ROAD",
            "address_2": "SUITE U-7",
            "city": "HEWLETT",
            "state": "NY",
            "postal_code": "115572326",
            "telephone_number": "516-792-0070",
            "fax_number": "516-706-6607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MILL ROAD",
            "address_2": "SUITE U-7",
            "city": "HEWLETT",
            "state": "NY",
            "postal_code": "115572326",
            "telephone_number": "516-792-0070",
            "fax_number": "516-706-6607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHASE TWO PODIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-28",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "PELCOVITZ",
        "authorized_official_first_name": "NACHUM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "516-792-0070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "N005974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hewlett, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; 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.