Active NPI
Lisa Aymong, NP
- Rehabilitation Clinic/Center
- Port Jefferson, NY
National Provider Identifier
1023336567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Clinic/Center
- License
- 302539
- Practice address
- 150 Dark Hollow Rd
Port Jefferson, NY 11777-2048 - Phone
- (631) 473-5400
- NPI assigned
- May 7, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | 302539 | NY | Primary |
Addresses
Primary practice location
150 Dark Hollow Rd
Port Jefferson, NY 11777-2048
Mailing address
150 Dark Hollow Road
Port Jefferson, NY 11777
Phone (631) 473-5400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302539 | NY | MD | Rehabilitation Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273190400000",
"number": "1023336567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 DARK HOLLOW ROAD",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "11777",
"telephone_number": "631-473-5400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 DARK HOLLOW RD",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772048",
"telephone_number": "631-473-5400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AYMONG",
"first_name": "LISA",
"name_prefix": "Ms.",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-07",
"last_updated": "2010-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "261QR0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation",
"state": "NY",
"license": "302539",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.