Individual provider Active NPI

Kelly Maurelus, M.D.

  • Emergency Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1942458526
Registry record updated Nov 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
264471 Issued in NY
Practice address
450 Clarkson Ave
Brooklyn, NY 11203-2012
Phone
(347) 733-5710
NPI assigned
Sep 8, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 264471 NY Primary

Addresses

Primary practice location

450 Clarkson Ave
Brooklyn, NY 11203-2012

Mailing address

2800 Marcus Ave
New Hyde Park, NY 11042-1113
Phone (516) 622-6000

Other identifiers 1

IdentifierTypeStateIssuer
264471OtherNYNEW YORK STATE LICENSE

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
I20120810000454 NY Practitioner - Emergency Medicine 7113173949 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
264471NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
University Hospital of Brooklyn Suny Downstate Health Sciences Univers Emergency Medicine CurrentSince Jan 1, 2022 Accepting new patients
Optum Urgent Care, PLLC CurrentSince Nov 9, 2015 Accepting new patients
Suny Health Science Center at Bklyn Emergency Medicine CurrentSince Nov 1, 2014 Accepting new patients
Coney Island Medical Practice Plan, P.C. CurrentSince Aug 9, 2013 Accepting new patients

Locations

470 Clarkson Ave
Brooklyn, NY 11203
Phone (718) 421-1003

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

450 Clarkson Ave
#59
Brooklyn, NY 11203
Phone (718) 270-2078

330 Court St
Brooklyn, NY 11231
Phone (347) 335-0062

450 Clarkson Ave
Brooklyn, NY 11203
Phone (718) 270-1603

555 N Broadway
Jericho, NY 11753
Phone (516) 597-5070

2800 Marcus Ave
New Hyde Park, NY 11042
Phone (516) 622-6131

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678

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": "1220832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446595200000",
    "number": "1942458526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 MARCUS AVE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421113",
            "telephone_number": "516-622-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032012",
            "telephone_number": "347-733-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAURELUS",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-08",
        "last_updated": "2015-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "264471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE LICENSE",
            "identifier": "264471",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.