Queens Nassau Nephrology Services PLLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

QUEENS NASSAU NEPHROLOGY SERVICES PLLC

Practice address

300 Old Country Road
111
Mineola, NY 11501-4112

Phone

(516) 745-0500

Fax

(516) 745-1534

NPI assigned

Jul 6, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Andrey Goncharuk, MDNPI 1356349922

Title

President

Phone

(516) 745-0500

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Tax ID family

Queens Nassau Nephrology Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Queens Nassau Nephrology Services PLLC

  • Nephrology Physician
  • Mineola, NY
  • NPI 1770988909
  NPD tax ID

Locations

Practitioners 7

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

• Vincent Steven Avila, M.D.

  • Nephrology Physician
  • Mineola, NY
  • NPI 1518965110

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Eduard Bover, D.O.

  • Nephrology Physician
  • Mineola, NY
  • NPI 1801831763
  Medicare reassignment Care Compare group NPD
• Andrey Goncharuk, M.D.

  • Nephrology Physician
  • Mineola, NY
  • NPI 1356349922
  Medicare reassignment NPD Authorized official
• Yelena Rosenberg, M.D.

  • Nephrology Physician
  • Mineola, NY
  • NPI 1598763187
  Medicare reassignment Care Compare group NPD
• Binny Koshy, M.D.

  • Nephrology Physician
  • Mineola, NY
  • NPI 1114925708
  Medicare reassignment Care Compare group
• Mario Marotta, M.D.

  • Nephrology Physician
  • Mineola, NY
  • NPI 1871591453
  Medicare reassignment Care Compare group
• Christopher Caputo, M.D.

  • Nephrology Physician
  • Mineola, NY
  • NPI 1992703490
  Medicare reassignment NPD

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

{
    "created_epoch": "1246838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417737600000",
    "number": "1992934467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 OLD COUNTRY ROAD",
            "address_2": "111",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014112",
            "telephone_number": "516-745-0500",
            "fax_number": "516-745-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OLD COUNTRY ROAD",
            "address_2": "111",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014112",
            "telephone_number": "516-745-0500",
            "fax_number": "516-745-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEENS NASSAU NEPHROLOGY SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-06",
        "last_updated": "2014-12-05",
        "status": "A",
        "authorized_official_last_name": "GONCHARUK",
        "authorized_official_first_name": "ANDREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-745-0500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "199896",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03340883",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joanne Susan Puntillo, RN
• Padmini Purwar, M.D.
• Sherri E Putterman, M.D.
• Michelle Lynn Quale, NP
• Queens Nassau Nephrology Services PLLC
• Queens Nassau Nephrology Services, P.C.
• Ashley Quinn, NP
• Catherine Quinn, C.R.N.P
• Grace Quinn
• Melanie A Quintal

• Nephrology Physician in Mineola, NY
• Providers in Mineola, 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 Dec 5, 2014; 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.