Mott Haven Professional Medical of New York LLC
Organization Active NPI Vascular Surgery Physician · Bronx, NY
NPI 1922525781 · NPPES record last updated Mar 26, 2018
Key facts
- NPI
- 1922525781
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Vascular Surgery Physician 2086S0129X
- License
- 265506 (NY)
- Legal business name
- MOTT HAVEN PROFESSIONAL MEDICAL OF NEW YORK LLC
- Practice address
- 384 E 149TH St
Bronx, NY 10455-3908 - Phone
- (718) 301-1100
- Fax
- (224) 246-8042
- NPI assigned
- Aug 23, 2017
- Organization subpart
- No
Authorized official
- Name
- Yan Katsnelson, MD
- Title
- Ceo
- Phone
- (847) 257-1244
Practitioners 36
-
Yan Katsnelson, M.D.
-
Ayman Abadeer, MD
-
Imtiaz Ahmad, M.D.
-
Mohammed Aladdin, MD
-
Michael C Banker, MD
-
Eric Berkowitz, MD
-
Michael Bezuevsky, D.O.
-
Stuart L Blackwood, M.D.
-
Richard Di Fiore, MD
-
Igor Fishkin, MD
-
Alexander Gart, MD
-
Eliezer Halpert, M.D.
-
Nay Htyte, M.D.
-
Stephen G Hurst, M.D.
-
Safet Lekperic, M.D.
-
Gina L. Louie, MD
-
Majid T Maybody, MD
-
Eugene Palchik, MD
-
Jeromy Ryan Patterson, M.D.
-
Aaron Dov Reichman, M.D.
-
Masahiko Satoda, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180410001065 | NY | Part B Supplier - Clinic/Group Practice | 5193088946 |
Receives reassigned benefits from 36 practitioners Practice locations: Bronx, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician |
2086S0129X | 265506 | NY | Yes |
Addresses
Primary practice location
384 E 149TH St
Bronx, NY 10455-3908
Mailing address
304 Wainwright Dr
Northbrook, IL 60062-1900
Phone (847) 257-1244
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036105104 | Medicaid | IL |
Other providers in Bronx, NY
- Motion Matrix Physical Therapy PLLC
- Mott Haven Medical of New York LLC
- Mott Haven Pharmacy Inc
- Mott Haven Phcy and Surgicals
- Mott Haven Prescription Inc
- Mott Haven RX Inc
- Sabrina C Motta
- Joe Mouawad
- Rita Moukarzel
- Jenna Mould
All providers in Bronx, NY · Vascular Surgery Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.