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ANDREA E NOMBERG PHYSICIAN PC
NPI 1295394120
Family Medicine in Ronkonkoma, NY

Active since June 13, 2019CLIA 33D2205780 · Waiver
622 HAWKINS AVE, RONKONKOMA, NY 11779(631) 583-3333 Get Directions Write a Review

NPPES record last updated: February 28, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Andrea E Nomberg Physician Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANDREA E NOMBERG PHYSICIAN PC (NPI 1295394120) is a healthcare organization registered as a family medicine in Ronkonkoma, New York and active in the NPI registry since June 2019. The organization holds a CLIA Waiver certificate valid through December 15, 2026 and lists Andrea Nomberg, Owner, as its authorized official.

NPPES Registry Identity

NPI1295394120
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameANDREA E NOMBERG PHYSICIAN PC
Location Address622 HAWKINS AVERonkonkoma, NY 11779-2374
Mailing Address1 Venezia CtDeer Park, NY 11729-1508
Phone(631) 583-3333
Organization SubpartNo
Authorized OfficialAndrea NombergOwner · (631) 583-3333
Enumeration DateJune 13, 2019
Last NPPES UpdateFebruary 28, 2024
NPPES CertifiedFebruary 28, 2024
✔ NPI 1295394120 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
622 HAWKINS AVE, Ronkonkoma, NY 11779
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Other Identifiers 1

Other102723NY · License

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Andrea E Nomberg Physician Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Andrea E Nomberg Physician PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Andrea Nomberg, MD
General Practice
NPI 1336223445
709 HAWKINS AVE
Ronkonkoma, NY 11779
(631) 588-0880
✔ PECOS✔ Accepts Medicare0.3 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2205780

Andrea E Nomberg MD Physician PC · Ronkonkoma, NY
Active · expires Dec 15, 2026
CLIA Number33D2205780
Laboratory TypePhysician Office
Certificate Effective DateDecember 16, 2024
Certificate Expiration DateDecember 15, 2026
Laboratory DirectorDr. Andrea E. Nomberg
Laboratory Phone(631) 583-3333
Laboratory LocationAndrea E Nomberg MD Physician PC622 Hawkins Ave, Ronkonkoma, NY 11779
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Andrea E Nomberg Physician PC's NPI number?

The NPI number for Andrea E Nomberg Physician PC is 1295394120. It was assigned to this organization in the NPPES registry on June 13, 2019.

Where is Andrea E Nomberg Physician PC located?

Andrea E Nomberg Physician PC is located at 622 Hawkins Ave, Ronkonkoma, NY 11779. The listed phone number is (631) 583-3333.

What is Andrea E Nomberg Physician PC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Andrea E Nomberg Physician PC enrolled in Medicare?

Yes. Andrea E Nomberg Physician PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Andrea E Nomberg Physician PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (General Practice) reassigns their Medicare billing to Andrea E Nomberg Physician PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Andrea E Nomberg Physician PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2205780) is associated with this NPI, valid through December 15, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Andrea E Nomberg Physician PC was last updated on February 28, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.