Flavia Gusmano, MD
Individual provider Active NPI Vascular Surgery Physician · Douglaston, NY
NPI 1992734693 · NPPES record last updated Oct 28, 2016
Key facts
- NPI
- 1992734693
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Vascular Surgery Physician 2086S0129X
- License
- 234942 (NY)
- Practice address
- 212 Ridge Rd
Douglaston, NY 11363-1309 - Phone
- (718) 423-7788
- Fax
- (718) 229-2222
- NPI assigned
- Jul 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- General Surgery
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- North Shore-Lij Medical PC
Practice addresses (Care Compare)
270 Park Ave
Huntington, NY 11743-2787
Phone (631) 351-2356
Hospital & facility affiliations
- NS/Lij HS Huntington Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051014000402 | NY | Practitioner - General Surgery | 5698791085 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 234942 | NY | MD | Surgery Physician |
Practice roles (2 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Shore-Lij Medical PC | Current |
Accepting new patients | |
| North Shore - Lij Medical PC | Current |
Accepting new patients |
Locations
270 Park Ave
Huntington, NY 11743
Phone (631) 351-2308
1554 Northern Blvd
Manhasset, NY 11030
Phone (516) 390-9242
1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650
300 Community Dr
Plandome, NY 11030
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 234942 | NY | |
| Vascular Surgery Physician | 2086S0129X | 234942 | NY | Yes |
Addresses
Primary practice location
212 Ridge Rd
Douglaston, NY 11363-1309
Mailing address
212 Ridge Rd
Douglaston, NY 11363-1309
Phone (718) 423-7788
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7172632 | Other | NY | AETNA |
| P010234942 | Other | NY | BLUE CHOICE |
| P020234942 | Other | NY | BLUE CROSS BLUE SHIELD |
| 02648864 | Medicaid | NY | |
| 161881FL | Other | NY | PREFERRED CARE |
Other providers in Douglaston, NY
- Michael James Golia
- Benhur Gonzales
- Elyse Gould
- GPR Associates Inc
- Bruce Greenberg
- Helmy W. Habek
- Diane Lois Haber
- Rachayl Haber
- Halcyon Acupuncture of Long Island PLLC
- Catherine Cascille Hampton
All providers in Douglaston, NY · Vascular Surgery Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.