Unknown Individual – Neuroradiology Physician, NPI 1366478174

Unknown Individual is a healthcare provider. based in Garden city, New York. specializing in Neuroradiology Physician. They hold a License No. 142637 (NY). The NPI Number for Unknown Individual is 1366478174

Main info

Organization
Inactive
47 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1366478174
Phone
(516) 222-2022
Address
990 STEWART AVE
Deactivation Date
13 December 2022

Doctor Profile

Medical School Name
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Secondary Phone
2122639701
Graduation Year
1979 (47 years ago)
PAC ID
9032182332
Group Practice PAC ID
1355232422
Professional Enrollment ID
I20040816000599
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Stewart Avenue, Garden City, Hempstead, Nassau County, New York, 11549, United States

    GARDEN CITY, NY 115304822

    Phone: (516) 222-2022

    Fax: (516) 222-8475

    Mailing address matches the actual address.

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 11530)

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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: 1355232422View full group profile
NameSpecialtyState
-PA
O B S T E T R I C S/ G Y N E C O L O G YNY
Internal MedicineNY
-NY
-NY
-NY
-NY
Anesthesiology, Addiction Medicine, Interventional Pain ManagementNY
Thoracic SurgeryNY
Nurse PractitionerNY

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1366478174 for Unknown Individual, then check state licensing separately.
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 primary classification?
Neuroradiology Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Garden City, New York in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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