Individual provider Active NPI

Gary Erwin Eddey, M.D.

  • Pediatrics Physician
  • New York, NY
National Provider Identifier
1942273388
Registry record updated Nov 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
158497 Issued in NY
Practice address
801 Amsterdam Ave
New York, NY 10025-5752
Phone
(212) 749-1820
NPI assigned
Feb 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MA05145000 NJ
Pediatrics Physician 208000000X 158497 NY Primary

Addresses

Primary practice location

801 Amsterdam Ave
New York, NY 10025-5752

Mailing address

801 Amsterdam Ave
New York, NY 10025-5752
Phone (212) 749-1820

Other identifiers 1

IdentifierTypeStateIssuer
0177903MedicaidNJ

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
I20170110001170 NY Practitioner - Pediatric Medicine 3779557087 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA05145000NJMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
William F Ryan Community Health Center Inc CurrentSince Dec 12, 2016 Accepting new patients
William F Ryan Community Health Center Inc CurrentSince Dec 12, 2016 Accepting new patients

Locations

110 W 97th St
New York, NY 10025
Phone (212) 316-7906

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Methany Medical and Educational CenterPeapack, NJ, CCN 312014 Hospital Corporate Officer (100%) Apr 22, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479427200000",
    "number": "1942273388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 AMSTERDAM AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100255752",
            "telephone_number": "212-749-1820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 AMSTERDAM AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100255752",
            "telephone_number": "212-749-1820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDDEY",
        "first_name": "GARY",
        "middle_name": "ERWIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2016-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA05145000",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "158497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0177903",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.