NPIMap

Organization Active NPI

Village Park Medical, PC

  • Infectious Disease Physician
  • New York, NY
National Provider Identifier
1902961097
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
VILLAGE PARK MEDICAL, PC
Practice address
31 Washington SQ W
4TH Floor
New York, NY 10011-9126
Phone
(212) 477-8833
Fax
(212) 982-1880
NPI assigned
Dec 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. William MandellNPI 1770555088
Title
President
Phone
(212) 475-8833

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
Infectious Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0200X Primary

Addresses

Primary practice location

31 Washington SQ W
4TH Floor
New York, NY 10011-9126

Mailing address

31 Washington SQ W
4TH Floor
New York, NY 10011-9126
Phone (212) 477-8833

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040313000619 NY Part B Supplier - Clinic/Group Practice 4688563943 Receives reassigned benefits from 10 practitioners
Practice locations: New York, NY

National Provider Directory

National Provider Directory

Locations

31 Washington Sq W
New York, NY 10011
Phone (212) 475-8833

31 Washington Sq W
Fl 4
New York, NY 10011
Phone (212) 475-8833

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902961097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 WASHINGTON SQ W",
            "address_2": "4TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100119126",
            "telephone_number": "212-477-8833",
            "fax_number": "212-982-1880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 WASHINGTON SQ W",
            "address_2": "4TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100119126",
            "telephone_number": "212-477-8833",
            "fax_number": "212-982-1880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE PARK MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANDELL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-475-8833",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.