CLOVELAKES ENT PC (NPI# 1619039815) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619039815 |
| Entity Type | Organization |
| Organization Name | CLOVELAKES ENT PC |
| Practice Address |
1414 Victory Blvd Staten Island NY 10301 |
| Practice Telephone | 7184471261 |
| Practice Fax Number | 7189811856 |
| Mailing Telephone | 7184471261 |
| Mailing Fax Number | 7189811856 |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. HELEN HYOSUN KIM (OWNER) |
| Authorized Official Telephone | 7184471261 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians |
| Street Address |
1414 VICTORY BLVD |
| City | STATEN ISLAND |
| State | NY |
| Zip Code | 10301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770067316 | Pulkit Arora | Speech-Language Pathologist | 1414 Victory Blvd, Staten Island, NY 10301-3908 | 2018-09-19 |
| 1306382478 | Janet Dellatacoma | Physician Assistant | 1414 Victory Blvd, Staten Island, NY 10301-3908 | 2017-01-13 |
| 1427473586 | Dina Masarsky | Physician Assistant | 1414 Victory Blvd, Staten Island, NY 10301-3908 | 2014-02-26 |
| 1114251949 | Santa Upeniece | Physician Assistant | 1414 Victory Blvd, Staten Island, NY 10301-3908 | 2009-09-26 |
| 1457527095 | John Mullin | Physician Assistant | 1414 Victory Blvd, Staten Island, NY 10301-3908 | 2008-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417586397 | Maria Duncan | Registered Nurse | Nurse Family Partnership, 358 St. Marks Place, 5th Floor, Staten Island, NY 10301 | 2020-04-03 |
| 1659835569 | Ipark Podiatry P.C. | Podiatrist | 970 Bard Avenue, Staten Island, NY 10301 | 2019-01-24 |
| 1386149789 | Dana Gioia | Specialist | 215 Hart Blvd Apt 5a, Staten Island, NY 10301 | 2018-03-27 |
| 1710404850 | Physical Therapy Unlimited | Preferred Provider Organization | 684 Ocean Terrace, Staten Island, NY 10301 | 2017-08-29 |
| 1356885438 | Jessica Glassman | Social Worker | 10 Dobbs Pl, Staten Island, NY 10301 | 2016-12-08 |
| 1679016372 | Amelia Rella | Speech-Language Pathologist | 60 Foote Ave, Staten Island, NY 10301 | 2016-11-29 |
| 1457714958 | Philip Kaplan | Dentist | 155 Bay Street, Unit C3, Staten Island, NY 10301 | 2016-04-01 |
| 1104284777 | Marie G Joseph | Social Worker | 2381 Hyland Blvd, Staten Island, NY 10301 | 2016-02-10 |
| 1700262565 | Courtney Pryor | Speech-Language Pathologist | 57 Westbury Avenue, Staten Island, NY 10301 | 2015-08-04 |
| 1710377999 | Jessica Maldarelli | Speech-Language Pathologist | 91 Henderson Avenue, Staten Island, NY 10301 | 2015-01-27 |
| Find all providers in zip 10301 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245542000 | Homere Al Moutran | Otolaryngology | 501 Seaview Ave Ste 202, Staten Island, NY 10305-3400 | 2010-07-09 |
| 1063420958 | Helen Hyosun Kim | Otolaryngology | 1414 Victory Boulevard, Staten Island, NY 10301 | 2006-08-04 |
| 1407817562 | John P Dodaro | Otolaryngology | 1 Teleport Dr Ste 200, Staten Island, NY 10311-1000 | 2006-03-29 |
| 1336122548 | Bartolomeo Vincent Castellano | Otolaryngology | 2052 Richmond Rd, 1c, Staten Island, NY 10306-2548 | 2005-11-22 |
| 1275927154 | Michael Amato | Otolaryngology | 1 Teleport Dr Ste 200, Staten Island, NY 10311-1000 | 2015-03-27 |
| 1740532829 | Peter J Miceli Md PC | Otolaryngology | 1550 Richmond Ave, Staten Island, NY 10314-1510 | 2012-10-12 |
| 1295026037 | Ansley Morgan Roche | Otolaryngology | 501 Seaview Ave Ste 202, Staten Island, NY 10305-3400 | 2011-04-27 |
| 1518132943 | Shawn Christopher Ciecko | Otolaryngology | 1 Teleport Dr Ste 200, Staten Island, NY 10311-1000 | 2008-04-27 |
| 1487701777 | Peter Joseph Miceli | Otolaryngology | 1 Teleport Dr Ste 200, Staten Island, NY 10311-1000 | 2007-01-05 |
| 1306907753 | Kenneth Wooh | Otolaryngology | 256 Mason Ave, Staten Island, NY 10305-3408 | 2006-12-12 |
| Find all providers in STATEN ISLAND | ||||
| City | STATEN ISLAND |
| Zip Code | 10301 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.