Active NPI
Neal Z. Potash, MS
- Social Worker
- Port Washington, WI
National Provider Identifier
1003955972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- PENDING
- Practice address
- 1317 W Grand Ave
Port Washington, WI 53074-2075 - Phone
- (262) 284-5789
- Fax
- (262) 284-5907
- NPI assigned
- Feb 6, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | PENDING | WI | Primary |
Addresses
Primary practice location
1317 W Grand Ave
Port Washington, WI 53074-2075
Mailing address
1317 W Grand Ave
Port Washington, WI 53074-2075
Phone (262) 284-5789
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43557600 | Medicaid | WI |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PENDING | WI | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003955972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1317 W GRAND AVE",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530742075",
"telephone_number": "262-284-5789",
"fax_number": "262-284-5907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1317 W GRAND AVE",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530742075",
"telephone_number": "262-284-5789",
"fax_number": "262-284-5907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTASH",
"first_name": "NEAL",
"middle_name": "Z.",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "PENDING",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43557600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Washington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.