NPIMap

Organization Active NPI

Maimonides Medical Center - MMC Gastroenterology FPP

  • Gastroenterology Physician
  • Brooklyn, NY
National Provider Identifier
1932216660
Registry record updated Feb 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
MAIMONIDES MEDICAL CENTER - MMC GASTROENTEROLOGY FPP
Practice address
4802 10TH Ave
Brooklyn, NY 11219-2916
Phone
(718) 283-8773
NPI assigned
Aug 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2013

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

Authorized official

Name
Edgar Lichstein, MD
Title
Department Chair
Phone
(718) 283-8773

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

4802 10TH Ave
Brooklyn, NY 11219-2916

Mailing address

Gpo Box 27641
New York, NY 10087-7641

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040320000522 NY Part B Supplier - Clinic/Group Practice 4981595055 Receives reassigned benefits from 29 practitioners
Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

249 Bridge St
Ste 211
Metuchen, NJ 08840

Practitioners & affiliated clinicians

Practitioners 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360713600000",
    "number": "1932216660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "GPO BOX 27641",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100877641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 10TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192916",
            "telephone_number": "718-283-8773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIMONIDES MEDICAL CENTER - MMC GASTROENTEROLOGY FPP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2013-02-13",
        "status": "A",
        "authorized_official_last_name": "LICHSTEIN",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_title_or_position": "DEPARTMENT CHAIR",
        "authorized_official_telephone_number": "718-283-8773",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2013; 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.