Village Family Practice, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

166889 Issued in NY

Legal business name

VILLAGE FAMILY PRACTICE, PC

Practice address

30 5TH Ave
New York, NY 10011-8859

Phone

(212) 477-1750

NPI assigned

Apr 6, 2009

Organization subpart

No

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

Authorized official

Name

Jerry Clements, MDNPI 1285721662

Title

President

Phone

(212) 477-1750

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Tax ID family

Village Family Practice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Village Family Practice

  • Primary Care Clinic/Center
  • New York, NY
  • NPI 1104182880
  NPD tax ID

Practitioners 2

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

• Jerry Eugene Clements, MD

  • Family Medicine Physician
  • New York, NY
  • NPI 1285721662
  Medicare reassignment NPD Authorized official
• Maria Stephanie Gbur, M.D.

  • Family Medicine Physician
  • New Rochelle, NY
  • NPI 1528398062
  NPD (past)

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271894400000",
    "number": "1902048911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 5TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100118859",
            "telephone_number": "212-477-1750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 5TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100118859",
            "telephone_number": "212-477-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE FAMILY PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2010-04-22",
        "status": "A",
        "authorized_official_last_name": "CLEMENTS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-477-1750",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "166889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Village Counsleing Licensed Clinical Social Work Services PLLC
• Village Diagnostic and Treatment Center
• Village Diagnostic and Treatment Center
• Village Eye Associates Inc.
• Village Family Practice
• Village Foot Care PC
• Village Group Medical PC
• Village Health Care Clinic
• Village Housing Development Corp
• Village Maternity Physicians, PLLC

• Family Medicine Physician in New York, NY
• Providers in New York, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2010; 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.