Photon Medical Group

Primary specialty

SpecialistTaxonomy code 174400000X

License

249723 Issued in NY

Legal business name

PHOTON MEDICAL GROUP

Practice address

808 Columbus Avenue, 21C
New York, NY 10025-5169

Phone

(646) 535-4180

NPI assigned

Aug 31, 2016

Organization subpart

No

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

Authorized official

Name

Alexis Young, MD

Title

Medical Director

Phone

(646) 535-4180

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472601600000",
    "number": "1972059749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 COLUMBUS AVENUE, 21C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100255169",
            "telephone_number": "646-535-4180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 COLUMBUS AVENUE, 21C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100255169",
            "telephone_number": "646-535-4180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOTON MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-31",
        "last_updated": "2016-08-31",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "646-535-4180",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "249723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in New York, NY
• Providers in New York, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.