Individual provider Active NPI

Kabita Ghosh-Hazra, MD

  • Pediatrics Physician
  • Bronx, NY
National Provider Identifier
1881779247
Registry record updated Feb 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
184957 Issued in NY
Practice address
654 Burke Ave
Bronx, NY 10467-6602
Phone
(718) 654-5900
Fax
(718) 654-0053
NPI assigned
Oct 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 184957 NY Primary

Addresses

Primary practice location

654 Burke Ave
Bronx, NY 10467-6602

Mailing address

654 Burke Ave
Bronx, NY 10467-6602
Phone (718) 654-5900

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090518000189 NY Practitioner - Pediatric Medicine 3971652231 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
184957NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center Pediatrics CurrentSince Mar 15, 2015 Accepting new patients
Montefiore Medical Center CurrentSince Mar 15, 2015 Accepting new patients

Locations

2100 Bartow Ave
Bronx, NY 10475
Phone (718) 320-5300

111 E 210th St
Bronx, NY 10467

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265155200000",
    "number": "1881779247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "654 BURKE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104676602",
            "telephone_number": "718-654-5900",
            "fax_number": "718-654-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "654 BURKE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104676602",
            "telephone_number": "718-654-5900",
            "fax_number": "718-654-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHOSH-HAZRA",
        "first_name": "KABITA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2010-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "184957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.