Provider Demographics
NPI:1467466581
Name:POWELL, JAMES ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:POWELL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 3RD AVE FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4151
Mailing Address - Country:US
Mailing Address - Phone:844-443-6246
Mailing Address - Fax:833-907-2235
Practice Address - Street 1:156 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4051
Practice Address - Country:US
Practice Address - Phone:844-443-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02109406Medicaid
NYH29367Medicare UPIN
NYWANA61Medicare PIN