Individual provider Active NPI

Jennifer Anne Eleazar, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Mount Kisco, NY
National Provider Identifier
1922119361
Registry record updated Nov 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
223449 Issued in NY
Practice address
90 S Bedford Rd
Care Mount Medical PC
Mount Kisco, NY 10549-3412
Phone
(914) 241-1050
Fax
(914) 242-1516
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 223449 NY Primary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 25MA07534800 NJ

Addresses

Primary practice location

90 S Bedford Rd
Care Mount Medical PC
Mount Kisco, NY 10549-3412

Mailing address

110 S Bedford Rd
Care Mount Medical PC
Mount Kisco, NY 10549-3446
Phone (914) 241-1050

Other identifiers 1

IdentifierTypeStateIssuer
02863014MedicaidNY

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
I20040910000986 NY Practitioner - Pathology 3476520362 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA07534800NJMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Feb 1, 2011 Accepting new patients
Optum Medical Care, P.C. CurrentSince Feb 1, 2011 Accepting new patients
Columbia Presbyterian Pathologists Anatomic Pathology & Clinical Pathology Past Accepting new patients
Trustees of Columbia University at Palisades Medical Center Anatomic Pathology & Clinical Pathology Past Accepting new patients

Locations

110 S Bedford Rd
Ste 3
Mount Kisco, NY 10549

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

Philadelphia, PA 19195

Organizations & group practices 4

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478822400000",
    "number": "1922119361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S BEDFORD RD",
            "address_2": "CARE MOUNT MEDICAL PC",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105493446",
            "telephone_number": "914-241-1050",
            "fax_number": "914-242-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 S BEDFORD RD",
            "address_2": "CARE MOUNT MEDICAL PC",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105493412",
            "telephone_number": "914-241-1050",
            "fax_number": "914-242-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELEAZAR",
        "first_name": "JENNIFER",
        "middle_name": "ANNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NY",
            "license": "223449",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NJ",
            "license": "25MA07534800",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02863014",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Kisco, NY

Sources for this page

Verify at the official NPI Registry.