Individual provider Active NPI

Engracio P. Cortes, M.D.

  • Hematology & Oncology Physician
  • Bayside, NY
National Provider Identifier
1902820996
Registry record updated Jan 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
111223 Issued in NY
Practice address
4564 Francis Lewis Blvd Ste 202
Bayside, NY 11361-3085
Phone
(631) 751-3000
Fax
(631) 751-3000
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 111223 NY Primary

Addresses

Primary practice location

4564 Francis Lewis Blvd Ste 202
Bayside, NY 11361-3085

Mailing address

1500 Route 112 BLDG 4
Port Jefferson Station, NY 11776-8055
Phone (631) 751-3000

Other identifiers 1

IdentifierTypeStateIssuer
00278506MedicaidNY

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
I20100507000557 NY Practitioner - Medical Oncology 7517095771 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
111223NYMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Hematology Oncology Associates PC CurrentSince Jan 1, 2017 Accepting new patients
Newyork-Presbyterian/Queens Past Accepting new patients
Booth Medical Associates PC Hematology & Oncology Past Accepting new patients

Locations

4564 Francis Lewis Blvd
Ste 202
Bayside, NY 11361

4008 Forley St
Flushing, NY 11373
Phone (718) 446-0270

3016 30th Dr
Long Island City, NY 11102
Phone (718) 728-3376

1500 Route 112
Bldg 4
Port Jefferson Station, NY 11776
Phone (631) 574-8354

1 Research Rd
Ridge, NY 11961

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

Organizations & group practices 3

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579219200000",
    "number": "1902820996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 ROUTE 112 BLDG 4",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768055",
            "telephone_number": "631-751-3000",
            "fax_number": "631-509-6559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4564 FRANCIS LEWIS BLVD STE 202",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613085",
            "telephone_number": "631-751-3000",
            "fax_number": "631-751-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORTES",
        "first_name": "ENGRACIO",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-01-17",
        "certification_date": "2020-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NY",
            "license": "111223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00278506",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayside, NY

Sources for this page

Verify at the official NPI Registry.