NPIMap

Organization Active NPI

Fpa Hospital Based

Doing business as Mount Sinai Dermatopathology Services III

  • Dermatopathology (Pathology) Physician
  • New York, NY
National Provider Identifier
1841531795
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology (Pathology) PhysicianTaxonomy code 207ZD0900X
License
CLIA 33D1051889 Issued in NY
Legal business name
FPA HOSPITAL BASED
Doing business as
Mount Sinai Dermatopathology Services III
Practice address
1468 Madison Ave
Annenberg 03-08
New York, NY 10029-6508
Phone
(212) 731-7772
Fax
(212) 534-7491
NPI assigned
Mar 1, 2013
Last updated
Mar 2, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
FPA HOSPITAL BASEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Authorized official

Name
Ms. Crystal Macneill, MBA
Title
VP, Cbo Director
Phone
(212) 241-6228

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology (Pathology) Physician 207ZD0900X CLIA 33D1051889 NY Primary

Addresses

Primary practice location

1468 Madison Ave
Annenberg 03-08
New York, NY 10029-6508

Mailing address

1468 Madison Ave
Annenberg 03-08
New York, NY 10029-6508
Phone (212) 241-6064

Other names 1

  • MOUNT SINAI DERMATOPATHOLOGY SERVICES III Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130806000185 NY Part B Supplier - Clinic/Group Practice 4789826694 Receives reassigned benefits from 1,308 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New York, NY; Staten Island, NY; Brooklyn, NY; Greenlawn, NY; Jackson Heights, NY; Long Island City, NY; Manhasset, NY

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Fpa Hospital Based4 organizations share this tax ID, including this one
Part of
Fpa Hospital Based

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3019 Crescent St
Long Island City, NY 11102
Phone (212) 731-3946

1090 Amsterdam Ave
Fl 3
New York, NY 10025
Phone (212) 523-8333

1468 Madison Ave
#175
New York, NY 10029
Phone (212) 241-8333

1468 Madison Ave
#308
New York, NY 10029

295 1st Ave
New York, NY 10003

421 W 113th St
New York, NY 10025
Phone (212) 241-2124

55 E 34th St
Fl 4
New York, NY 10016
Phone (212) 252-6004

787 11th Ave
Fl 7
New York, NY 10019
Phone (212) 523-8222

800A 5th Ave
Ste 202
New York, NY 10065
Phone (212) 421-4845

Practitioners & affiliated clinicians

Practitioners 1,359

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 1,359

NPI Registry JSON

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

{
    "created_epoch": "1362096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425254400000",
    "number": "1841531795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1468 MADISON AVE",
            "address_2": "ANNENBERG 03-08",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296508",
            "telephone_number": "212-241-6064",
            "fax_number": "212-241-7832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1468 MADISON AVE",
            "address_2": "ANNENBERG 03-08",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296508",
            "telephone_number": "212-731-7772",
            "fax_number": "212-534-7491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FPA HOSPITAL BASED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FPA HOSPITAL BASED",
        "enumeration_date": "2013-03-01",
        "last_updated": "2015-03-02",
        "status": "A",
        "authorized_official_last_name": "MACNEILL",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "VP, CBO DIRECTOR",
        "authorized_official_telephone_number": "212-241-6228",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "NY",
            "license": "CLIA 33D1051889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOUNT SINAI DERMATOPATHOLOGY SERVICES III",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; 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.