East Northport Medical Care PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

170689 Issued in NY

Legal business name

EAST NORTHPORT MEDICAL CARE PLLC

Practice address

554 Larkfield Rd
Suite 101
East Northport, NY 11731-4205

Phone

(631) 368-9166

Fax

(631) 368-5682

NPI assigned

Feb 12, 2010

Last updated

May 19, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Anthony J Antonucci, MD

Title

Partner

Phone

(631) 368-9166

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HEFFDD

Practitioners 2

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.

• Rose Nkoli Ezeani, NP

  • Adult Health Nurse Practitioner
  • West Islip, NY
  • NPI 1609921568
  Medicare reassignment NPD
• Amir Herman, D.O.

  • Adult Medicine Physician
  • East Northport, NY
  • NPI 1306867494
  Medicare reassignment NPD

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

{
    "created_epoch": "1265932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274227200000",
    "number": "1932431103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "554 LARKFIELD RD",
            "address_2": "SUITE 101",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117314205",
            "telephone_number": "631-368-9166",
            "fax_number": "631-368-5682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "554 LARKFIELD RD",
            "address_2": "SUITE 101",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117314205",
            "telephone_number": "631-368-9166",
            "fax_number": "631-368-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST NORTHPORT MEDICAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-12",
        "last_updated": "2010-05-19",
        "status": "A",
        "authorized_official_last_name": "ANTONUCCI",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "631-368-9166",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "226879",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "170689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Rose Dube, LPN
• Shawna Dullaghan, RD
• Jessica Louise Dwyer-Golembiowski, MS
• Dynamic Wellness Inc.
• East Northport Fire District
• Elizabeth Ann Eckhardt, LCSW, PHD
• Anna Elkiki
• Susan Ann Ellenis, M.S.
• Beth Wren Elliott, LMT
• Empire Vision Center Inc (Davis Vision)

• Internal Medicine Physician in East Northport, NY
• Providers in East Northport, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.