Sisselman Medical Group, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

216161 Issued in NY

Legal business name

SISSELMAN MEDICAL GROUP, PC

Practice address

627 Broadway
Suite 1
Massapequa, NY 11758-5031

Phone

(516) 308-4040

Fax

(516) 804-6386

NPI assigned

Nov 26, 2007

Last updated

Oct 12, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Stephen Sisselman, D.O.NPI 1609948884

Title

President

Phone

(516) 308-4040

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

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.

• Stephen G Sisselman, DO

  • Internal Medicine Physician
  • Massapequa, NY
  • NPI 1609948884
  Medicare reassignment Care Compare group NPD Authorized official
• Lauren Iarrobino

  • Adult Health Nurse Practitioner
  • Amityville, NY
  • NPI 1710362728
  Medicare reassignment Care Compare group NPD
• Sabrina Mackittrick, NP

  • Adult Health Nurse Practitioner
  • New Hyde Park, NY
  • NPI 1699196683
  Medicare reassignment Care Compare group NPD
• Jill Sisselman, D.O.

  • Family Medicine Physician
  • Massapequa, NY
  • NPI 1295895480
  Medicare reassignment Care Compare group NPD
• Erin Peyton-Alt, RPA-C

  • Medical Physician Assistant
  • Hempstead, NY
  • NPI 1104981927
  Medicare reassignment Care Compare group
• Amy L Roberts, RPA-C

  • Physician Assistant
  • Massapequa, NY
  • NPI 1083904494
  Medicare reassignment
• Elizabeth Anne Westendorf, PA-C

  • Medical Physician Assistant
  • Patchogue, NY
  • NPI 1821387937
  Medicare reassignment

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

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1851572358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 BROADWAY",
            "address_2": "SUITE 1",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585031",
            "telephone_number": "516-308-4040",
            "fax_number": "516-804-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 BROADWAY",
            "address_2": "SUITE 1",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585031",
            "telephone_number": "516-308-4040",
            "fax_number": "516-804-6386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SISSELMAN MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-26",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "SISSELMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-308-4040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "216154",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "216161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05215494",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lori B Sinclair, LCSW
• Sahida Singh-Rhoden, BCBA, LBA
• Kamalpreet Singh, DDS
• Tejpreet Singh, MD
• Geneva Anne Sisalima
• Jill Sisselman, D.O.
• Stephen G Sisselman, DO
• Christine Karen Sklar
• Margaret Mary Slayback, LCSW-R, CASAC
• Jacqueline Marie Slomin, RD

• Internal Medicine Physician in Massapequa, NY
• Providers in Massapequa, 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 Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.