Unknown Individual – Sports Medicine (Orthopaedic Surgery) Physician, NPI 1679578462

Sports Medicine (Orthopaedic Surgery) Physician

Unknown Individual is a healthcare provider. based in Stamford, Connecticut. specializing in Sports Medicine (Orthopaedic Surgery) Physician. They hold a License No. 203798 (NY). The NPI Number for Unknown Individual is 1679578462

Main info

Organization

Inactive

32 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1679578462

Phone

(914) 249-7000

Address

1290 SUMMER ST

Deactivation Date

3 February 2022

Doctor Profile

Medical School Name

ALBERT EINSTEIN COLLEGE OF MEDICINE OF YESHIVA UNIVERSITY

Secondary Phone

2037854638

Graduation Year

1994 (32 years ago)

PAC ID

1658327226

Group Practice PAC ID

9436061736

Professional Enrollment ID

I20090217000615

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience23

Completeness75

Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

1290, Summer Street, Northfield, Stamford, Fairfield County, Connecticut, 06905, United States
STE 4400
STAMFORD, CT 069055331
Phone: (914) 249-7000
Fax: (914) 249-7032
Type: Mailing
31, Strawberry Hill Avenue, Glenbrook, Lawnhill Terrace, Stamford, Fairfield County, Connecticut, 06902, United States
STAMFORD, CT 069022608
Phone: (203) 325-8888
Fax: (203) 359-2344
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 06905)

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Provider's Procedures

Unknown Individual performs procedures in Sports Medicine (Orthopaedic Surgery) Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
ORTHOPEDIC SURGERY	CT	20610	Aspiration and/or injection of large joint or joint capsule	122	48
ORTHOPEDIC SURGERY	CT	97110	Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes	396	15

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 9436061736View full group profile

Name	Specialty	State
DR. BRIAN CHRISTOPHER CAMBI (M.D.)	Interventional Cardiology, Cardiovascular Disease (Cardiology)	CT
FRANCESCA MONTANARI (MD)	H E M A T O L O G Y/ O N C O L O G Y	CT
MS. MARYAM GONDAL (M.D.)	Internal Medicine, Nephrology	SC
MATTHEW JOSEPH MCCONNELL (M.D.)	-	CT
DR. DANICE KURUVILLA (M.D.)	-	NC
JEANETTE M TETRAULT (MD)	Internal Medicine	CT
LOUIS WANG (MD)	-	CT
DR. PRAMOD BONDE (MD)	Cardiac Surgery	CT
DR. LUMING LI (MD)	-	CT
Unknown Individual	-	CT

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?

NPI numbers are unique to each provider or organization — Unknown Individual uses 1679578462.

What dates should I check for Unknown Individual's activity?

We display what the registry publishes: Unknown Individual appears inactive there.

What is Unknown Individual's specialty?

The listing groups Unknown Individual with Sports Medicine (Orthopaedic Surgery) Physician. Clinical services aligned with this taxonomy classification.

Where should I expect Unknown Individual on a map?

Expect Stamford, Connecticut as a primary anchor for Unknown Individual unless the record lists multiple sites.

Is the information about Unknown Individual up to date?

Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."