NPIMap

Organization Active NPI

Gastroenterology & Liver Disease, PC

  • Specialist
  • Forest Hills, NY
National Provider Identifier
1891034500
Registry record updated Mar 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
244590 Issued in NY
Legal business name
GASTROENTEROLOGY & LIVER DISEASE, PC
Practice address
10721 Queens Blvd
Suite 4
Forest Hills, NY 11375-4413
Phone
(718) 520-0857
Fax
(718) 520-9099
NPI assigned
Feb 1, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2013

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

Authorized official

Name
Dr. Albert Shalomov, M.DNPI 1770775025
Title
President
Phone
(718) 520-0857

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 244590 NY Primary

Addresses

Primary practice location

10721 Queens Blvd
Suite 4
Forest Hills, NY 11375-4413

Mailing address

10721 Queens Blvd
Suite 4
Forest Hills, NY 11375-4413
Phone (718) 520-0857

Other identifiers 1

IdentifierTypeStateIssuer
02914441MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130314000250 NY Part B Supplier - Clinic/Group Practice 7113162439 Receives reassigned benefits from 6 practitioners
Practice locations: Forest Hills, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1359676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363046400000",
    "number": "1891034500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10721 QUEENS BLVD",
            "address_2": "SUITE 4",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113754413",
            "telephone_number": "718-520-0857",
            "fax_number": "718-520-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10721 QUEENS BLVD",
            "address_2": "SUITE 4",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113754413",
            "telephone_number": "718-520-0857",
            "fax_number": "718-520-9099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY & LIVER DISEASE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-01",
        "last_updated": "2013-03-12",
        "status": "A",
        "authorized_official_last_name": "SHALOMOV",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-520-0857",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "244590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02914441",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; 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.