Central Park Physical Medicine PC
NPI 1174848501ActiveOrganization· Specialist· Laurelton, NY
Specialist in Laurelton, New York, registered in NPPES in March 2010. The authorized official on file is Samuel Michael Theagene, MD, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1174848501 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 29, 2010 |
| Last updated in NPPES | Mar 30, 2015 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Specialist Primary | 174400000X | 194218-1 | NY |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (NY) |
|---|
Other Specialist providers in Laurelton
- 1487917456
- 1649870981
- 1912511619
- 1710846274
- 1679835854
- 1154685816
- 1700766391
- 1114302205
- 1386296994
- 1679720510
- 1205262102
- 1275947368