Manuel Licitra Fajardo, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

279410 Issued in NY

Practice address

100 Somerset Ave
Garden City
Garden City, NY 11530-1231

Phone

(516) 741-4898

NPI assigned

Jan 30, 2012

Last updated

Jan 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mount Sinai School of MedicineGroup PAC ID 6406096544, 150 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mount Sinai South Nassau Hospital, Oceanside, NY, CCN 330198

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as apm

Quality

85.32

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: manuelfajardo@snch.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mount Sinai School of Medicine

  dba Mount Sinai Marathon Medical

  • Internal Medicine Physician
  • Oceanside, NY
  • NPI 1508127531
  Medicare reassignment Care Compare group NPD
• 24 On Physicians, PC

  • Hospitalist Physician
  • Far Rockaway, NY
  • NPI 1578781787
  Medicare reassignment NPD
• Lawrence Medical Associates, PC

  dba NewYork-Presbyterian Medical Group/Westchester

  • Internal Medicine Physician
  • Yorktown Heights, NY
  • NPI 1023257441
  Medicare reassignment NPD
• North Shore-Lij Medical PC

  dba NHPP Cardiology at Great Neck

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572

  Internal Medicine

  Medicare reassignment NPD
• Port Emergency Medical Services, P.C.

  • Emergency Medicine Physician
  • Port Jefferson, NY
  • NPI 1912988395
  Medicare reassignment NPD
• United Medical Associates PC

  • Clinic/Center
  • Binghamton, NY
  • NPI 1013972801
  Medicare reassignment NPD
• Lawrence Medical Associates, PC

  dba Newyork-Presbyterian Medical Group/Westchester

  • Multi-Specialty Clinic/Center
  • Yorktown Heights, NY
  • NPI 1184115479
  NPD
• Mount Sinai School of Medicine

  • Psychiatry Physician
  • Hempstead, NY
  • NPI 1508333956
  NPD
• Mount Sinai School of Medicine

  • Hematology & Oncology Physician
  • Merrick, NY
  • NPI 1720555089
  NPD
• North Shore - Lij Medical PC

  dba NSLIJ Medical In Queens

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD
• South Nassau Communities Hospital

  • General Acute Care Hospital
  • Oceanside, NY
  • NPI 1922079094
  NPD
• United Medical Associates, P.C.

  • Durable Medical Equipment & Medical Supplies
  • Binghamton, NY
  • NPI 1629252556
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• South Nassau Communities Hospital

  • General Acute Care Hospital
  • Oceanside, NY
  • NPI 1922079094
  Care Compare affiliation

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

{
    "created_epoch": "1327881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1831461417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SOMERSET AVE",
            "address_2": "GARDEN CITY",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115301231",
            "telephone_number": "516-741-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SOMERSET AVE",
            "address_2": "GARDEN CITY",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115301231",
            "telephone_number": "516-741-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAJARDO",
        "first_name": "MANUEL",
        "middle_name": "LICITRA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-30",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "53519",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "279410",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "53519",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "279410",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "55 Palmer Ave",
            "city": "Bronxville",
            "state": "NY",
            "country_code": "US",
            "postal_code": "107083491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "55 Palmer Ave",
            "city": "Bronxville",
            "state": "NY",
            "country_code": "US",
            "postal_code": "107083491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "maf9321@direct.nyp.org",
            "affiliation": "N",
            "endpointDescription": "Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct address",
            "address_1": "55 Palmer Ave",
            "city": "Bronxville",
            "state": "NY",
            "country_code": "US",
            "postal_code": "107083491",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eyeguys LLP (Stahl Eye Associates)
• Janet Rose Fabian, LCSW
• Renee Fabus, PH.D. CCC-SLP, TSHH
• Louis Faiella, MD
• Brittany Monique Faison
• Brianna Lynne Falgoust, OTR/L
• Jeffrey M Falk, M.D.
• Pamela Ellen Falletta, MA
• Lauren Grace Fallon, AGACNP
• Omodolapo Familusi, AGNP

• Internal Medicine Physician in Garden City, NY
• Providers in Garden City, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.