105 EAST 78 STREET MEDICAL — NPI 1578852588 (Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) in NEW YORK, NY)

CMS-1500 Box 24J / 33a • NPI

1578852588

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

174400000X

Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)

Box 32 Service Location & ZIP+4

885 PARK AVE, SUITE 105, NEW YORK, NY, 10075-0325

✓ 9-Digit EDI 837 ZIP+4 (10075-0325)

Practice Phone & Referral Fax

(212) 535-3313

Fax: (212) 734-3192

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1578852588 (105 EAST 78 STREET MEDICAL) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1578852588` (NPI-2 Organization / Facility)
Provider / Legal Name	105 EAST 78 STREET MEDICAL
Plain-English Specialty	Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) NUCC Code: `174400000X` (Specialist)
Certifying / Licensing Body	American Board of Pediatrics (ABP)
Practice Location Address	885 PARK AVE, SUITE 105, NEW YORK, NY, 10075-0325
Practice Telephone / Fax	Tel: (212) 535-3313 \| Fax: (212) 734-3192
Administrative Mailing Address	885 PARK AVE, NEW YORK, NY, 10075-0325
Enumeration & Last Sync	Enumerated: 2011-03-30 \| CMS Record Updated: 2011-03-30
Authorized Official	EVERETT LAUTIN (President)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

885 PARK AVE, SUITE 105, NEW YORK, NY, 10075-0325

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Plain-English Taxonomy & CMS Crosswalk (174400000X)

What Does Taxonomy Code 174400000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 174400000X translates to:
"Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: American Board of Pediatrics (ABP)
Clinical Scope: Newborn jaundice screening, routine childhood vaccinations, developmental milestones, pediatric fevers, ear infections, asthma, or acute gastroenteritis.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (105 EAST 78 STREET MEDICAL)

Typical CPT / Diagnostic Procedures:

Comprehensive Well-Child Developmental & Growth Visits (CPT 99381–99394)
Childhood Immunization Administration (Rotavirus, MMR, DTaP, HPV, PCV)
Neonatal Bilirubin & Jaundice Transcutaneous/Serum Screening
Rapid Streptococcal, RSV & Influenza Point-of-Care Diagnostics
Pediatric Asthma Nebulization & Spirometry Evaluation

Common Therapeutic Classes:

Amoxicillin / Amoxicillin-Clavulanate (Pediatric Otitis Media & Sinusitis)
WHO Low-Osmolarity Oral Rehydration Salts (ORS) & Zinc Sulfate
Albuterol Sulfate Inhalers & Fluticasone Pediatric Inhalers
Weight-Based Acetaminophen & Ibuprofen Antipyretic Suspensions

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`174400000X` — Specialist Plain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)	State: NY \| License: `60112817` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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105 EAST 78 STREET MEDICAL (NPI #1578852588)