Organization Active NPI

Neuroaxis Neurosurgical Assoc P.C.

  • Neurological Surgery Physician
  • Rego Park, NY
National Provider Identifier
1952573644
Registry record updated Jul 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
160105 Issued in NY
Legal business name
NEUROAXIS NEUROSURGICAL ASSOC P.C.
Practice address
9525 Queens Blvd
2ND Floor, Dept. of Neurosurgery
Rego Park, NY 11374-4511
Phone
(718) 459-7700
Fax
(718) 286-1140
NPI assigned
Apr 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2008

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

Authorized official

Name
Dr. John I Miller, M.D.NPI 1285788265
Title
Partner
Phone
(718) 459-7700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207T00000X 160105 NY Primary
Neurological Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207T00000X 180402 NY
Neurological Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207T00000X 194649 NY
Neurological Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207T00000X 202873 NY

Addresses

Primary practice location

9525 Queens Blvd
2ND Floor, Dept. of Neurosurgery
Rego Park, NY 11374-4511

Mailing address

PO Box 747821
Rego Park, NY 11374-7821
Phone (718) 459-7700

Other identifiers 4

IdentifierTypeStateIssuer
01750081MedicaidNY
01027412MedicaidNY
02061503MedicaidNY
01514929MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040320000112 NY Part B Supplier - Clinic/Group Practice 7113818238 Receives reassigned benefits from 6 practitioners
Practice locations: Brooklyn, NY; Garden City, NY; Greenvale, NY; Kew Gardens, NY; New York, NY; Richmond Hill, NY; Roslyn, NY

National Provider Directory

National Provider Directory

Locations

3907 Prince St
Ste 6D
Flushing, NY 11354
Phone (718) 888-1807

8002 Kew Gardens Rd
Ste 703
Kew Gardens, NY 11415
Phone (718) 459-7700

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1952573644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 747821",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113747821",
            "telephone_number": "718-459-7700",
            "fax_number": "718-286-1140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9525 QUEENS BLVD",
            "address_2": "2ND FLOOR, DEPT. OF NEUROSURGERY",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744511",
            "telephone_number": "718-459-7700",
            "fax_number": "718-286-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROAXIS NEUROSURGICAL ASSOC P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "718-459-7700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "NY",
            "license": "160105",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "NY",
            "license": "180402",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "NY",
            "license": "194649",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "NY",
            "license": "202873",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01750081",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01027412",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02061503",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01514929",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; 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.