Active NPI
Jennifer Disla
- Specialist
- Corona, NY
National Provider Identifier
1003249020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1191109
- Practice address
- 11172 42ND Ave
Corona, NY 11368-2620 - Phone
- (718) 458-0571
- NPI assigned
- Aug 13, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1191109 | NY | Primary |
Addresses
Primary practice location
11172 42ND Ave
Corona, NY 11368-2620
Mailing address
111-72 42ND Avenue
Corona, MT 11368
Phone (718) 458-0571
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1191109 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376352000000",
"number": "1003249020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111-72 42ND AVENUE",
"city": "CORONA",
"state": "MT",
"postal_code": "11368",
"telephone_number": "718-458-0571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11172 42ND AVE",
"city": "CORONA",
"state": "NY",
"postal_code": "113682620",
"telephone_number": "718-458-0571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISLA",
"first_name": "JENNIFER",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-13",
"last_updated": "2013-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "1191109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.