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MOTT HAVEN PROFESSIONAL MEDICAL OF NEW YORK LLC
NPI 1922525781
Surgery - Vascular Surgery in Bronx, NY

Active since August 23, 2017CLIA 33D2157722 · Waiver
384 E 149TH ST, BRONX, NY 10455(718) 301-1100(224) 246-8042 Get Directions Write a Review

NPPES record last updated: March 26, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 26, 2018, Aug 23, 2017 (2 updates tracked since 2017).

About Mott Haven Professional Medical Of New York Llc NPPES

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

MOTT HAVEN PROFESSIONAL MEDICAL OF NEW YORK LLC (NPI 1922525781) is a healthcare organization registered as a vascular surgery in Bronx, New York and active in the NPI registry since August 2017. The organization holds a CLIA Waiver certificate valid through November 17, 2027 and lists Yan Katsnelson, Ceo, as its authorized official.

NPPES Registry Identity

NPI1922525781
Entity TypeOrganization
Primary Taxonomy2086S0129X
Legal Business NameMOTT HAVEN PROFESSIONAL MEDICAL OF NEW YORK LLC
Location Address384 E 149TH STBronx, NY 10455-3908
Mailing Address304 Wainwright DrNorthbrook, IL 60062-1900 · (847) 257-1244 · Fax (224) 246-8042
Phone(718) 301-1100
Fax(224) 246-8042
Organization SubpartNo
Authorized OfficialYan KatsnelsonCeo · (847) 257-1244
Enumeration DateAugust 23, 2017
Last NPPES UpdateMarch 26, 20182 updates tracked since enumeration
✔ NPI 1922525781 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Vascular SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0129X
License✔ Licensed in NY · 265506
Definition
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
384 E 149TH ST, Bronx, NY 10455
Open in Google Maps ↗

Other Identifiers 1

Medicaid036105104IL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 33D2157722

Mott Haven Professional Medical Of New York LLC · Bronx, NY
Active · expires Nov 17, 2027
CLIA Number33D2157722
Laboratory TypePhysician Office
Certificate Effective DateNovember 18, 2025
Certificate Expiration DateNovember 17, 2027
Laboratory DirectorDr. Jacob M. White
Laboratory Phone(847) 257-1237
Laboratory LocationMott Haven Professional Medical Of New York LLC384 E 149th Street - Ste 201A, Bronx, NY 10455
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CITYWIDE DENTAL FAMILY PRACTICE, PLLC
Dentist (General Practice)
384 E 149TH ST, SUITE 216
BRONX, NY 10455
Bronx County (718) 993-7788
MS. M KIM TALMOR OTR
Occupational Therapist
384 E 149TH ST
BRONX, NY 10455
Bronx County (718) 585-0614
ESTHER J JAIME WSP
Behavior Analyst
384 E 149TH ST
BRONX, NY 10455
Bronx County (646) 283-1779
JESTINE DEVARGE JENNINGS LCSW
Social Worker (Clinical)
384 E 149TH ST
BRONX, NY 10455
Bronx County (631) 983-7298
JENNIFER BUENO
Behavior Analyst
384 E 149TH ST
BRONX, NY 10455
Bronx County (347) 293-4101
SKILLS TO BE A KID, OT SERVICES, PLLC
Occupational Therapist (Pediatrics)
384 E 149TH ST, SUITE 614
BRONX, NY 10455
Bronx County (718) 585-0614
MRS. LILIANA CONSUELO MARTINEZ M.S.,OTR/L
Occupational Therapist (Pediatrics)
384 E 149TH ST, SUITE 614
BRONX, NY 10455
Bronx County (718) 585-0614
FALCON MEDICAL CARE
Clinic/Center (Multi-Specialty)
384 E 149TH ST
BRONX, NY 10455
Bronx County (718) 742-1100

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 Mott Haven Professional Medical Of New York LLC's NPI number?

The NPI number for Mott Haven Professional Medical Of New York LLC is 1922525781. It was assigned to this organization in the NPPES registry on August 23, 2017.

Where is Mott Haven Professional Medical Of New York LLC located?

Mott Haven Professional Medical Of New York LLC is located at 384 E 149th St, Bronx, NY 10455. The listed phone number is (718) 301-1100.

What is Mott Haven Professional Medical Of New York LLC's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Vascular Surgery, with taxonomy code 2086S0129X.

Does Mott Haven Professional Medical Of New York LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2157722) is associated with this NPI, valid through November 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mott Haven Professional Medical Of New York LLC was last updated on March 26, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.