Paul Promadhattvedi, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

301528 Issued in NY

Practice address

255 Fort Washington Ave Apt 41
New York, NY 10032-1252

Phone

(917) 328-3232

NPI assigned

May 4, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Brookview Medical Associates, PLLC

  • General Practice Physician
  • Bohemia, NY
  • NPI 1871965855
  Medicare reassignment NPD

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

{
    "created_epoch": "1493856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576368000000",
    "number": "1992231294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 FORT WASHINGTON AVE",
            "address_2": "APT 41",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321229",
            "telephone_number": "917-328-3232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 FORT WASHINGTON AVE APT 41",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321252",
            "telephone_number": "917-328-3232"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 Lansdowne Ave",
            "address_purpose": "LOCATION",
            "city": "Darby",
            "state": "PA",
            "postal_code": "190231200",
            "country_code": "US",
            "telephone_number": "610-237-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROMADHATTVEDI",
        "first_name": "PAUL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-04",
        "last_updated": "2019-12-15",
        "certification_date": "2019-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT212736",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "301528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lukas K Prokes, PSYD., LCAT
• Alla Prokhovnik-Raphique, PH.D.
• Michelle Ester Prokofiev
• Anthony Joseph Proli II, PHARMD
• Prolific Care Health Enterprises LLC
• Promed Agency
• Promeds Pharmacy Group, Inc.
• Promenade Medical Care PC
• Promobility Physical Therapy, P.C.
• Prompt Care Inc

• General Practice Physician in New York, NY
• Providers in New York, NY by specialty
• General Practice Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.