Staten Island Nephrology PC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

STATEN ISLAND NEPHROLOGY PC

Practice address

1366 Victory Blvd
Staten Island, NY 10301-3907

Phone

(718) 727-3402

Fax

(718) 727-3402

NPI assigned

Jan 9, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Eugene Petra, MD

Title

Owner

Phone

(718) 273-3400

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Grossman, MDQ

  • Nephrology Physician
  • Staten Island, NY
  • NPI 1962513424
  Medicare reassignment Care Compare group NPD
• Jaudat H Khan, MD

  • Nephrology Physician
  • Staten Island, NY
  • NPI 1457683179
  Medicare reassignment Care Compare group NPD
• Judith McLoughlin, MD

  • Nephrology Physician
  • Staten Island, NY
  • NPI 1013995190
  Medicare reassignment Care Compare group NPD
• Meilin Zhang, MD

  • Nephrology Physician
  • Staten Island, NY
  • NPI 1083692727
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202428800000",
    "number": "1982682001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1366 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103013907",
            "telephone_number": "718-727-3402",
            "fax_number": "718-727-3402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1366 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103013907",
            "telephone_number": "718-727-3402",
            "fax_number": "718-727-3402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND NEPHROLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-09",
        "last_updated": "2008-02-08",
        "status": "A",
        "authorized_official_last_name": "PETRA",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-273-3400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02544181",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Staten Island Mental Health Society
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• Staten Island Mental Health Society, Inc.
• Staten Island Neonatology PC
• Staten Island Ophthalmology, PC
• Staten Island Oral & Maxillofacial Surgery
• Staten Island Orthopedics & Sports Medicine P.C
• Staten Island Pain & Rehabilitation, P.C.
• Staten Island Pediatric Cardiology, PLLC

• Nephrology Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Nephrology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.