Excelsior Integrated Medical Group, PLLC

Primary specialty

Mammography Clinic/CenterTaxonomy code 261QR0206X

Legal business name

EXCELSIOR INTEGRATED MEDICAL GROUP, PLLC

Doing business as

Healthier Imaging & Lab, Inc

Practice address

758 61St St
Brooklyn, NY 11220-4212

Phone

(718) 522-1118

Fax

(212) 335-0320

NPI assigned

Feb 19, 2016

Organization subpart

No

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

Authorized official

Name

George Hall, M.D.

Title

President

Phone

(212) 335-0328

Specialties & licenses 3

Addresses

Other names 1

• Healthier Imaging & Lab, Inc Doing business as

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 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Simon Zaw Moe Thein, M.B.,B.S.

  • Cardiovascular Disease Physician
  • Brooklyn, NY
  • NPI 1740501055
  NPD
• Howard Xu, FNP

  • Family Nurse Practitioner
  • Flushing, NY
  • NPI 1609341890
  NPD
• James Cai

  • Physician Assistant
  • Edison, NJ
  • NPI 1215331152
  NPD

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

{
    "created_epoch": "1455840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591920000000",
    "number": "1881053775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 BOWERY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100134888",
            "telephone_number": "212-335-0328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 61ST ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112204212",
            "telephone_number": "718-522-1118",
            "fax_number": "212-335-0320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "94 Bowery",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100134888",
            "country_code": "US",
            "telephone_number": "212-335-0328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EXCELSIOR INTEGRATED MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-19",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-335-0328",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "250205",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "228377",
            "primary": false
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthier Imaging & Lab, Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Healthier Imaging & Lab, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mammography Clinic/Center in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Mammography Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.