Active NPI
Rachael Avery Burgess
- Occupational Therapy Assistant
- The Bronx, NY
National Provider Identifier
1023614252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 10593-01
- Practice address
- 1909 Longfellow Avenue
The Bronx, NY 10460 - Phone
- (347) 497-3998
- NPI assigned
- Dec 11, 2020
- Last updated
- Dec 11, 2020
- 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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 10593-01 | NY | Primary |
Addresses
Primary practice location
1909 Longfellow Avenue
The Bronx, NY 10460
Mailing address
37 Mountain Lakes Dr
Wanaque, NJ 07465-1016
Other practice location 1
205 Conklintown Rd
Wanaque, NJ 07465-2122
Phone (973) 835-3900
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 |
|---|---|---|---|
| 10593-01 | NY | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607644800000",
"number": "1023614252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 MOUNTAIN LAKES DR",
"city": "WANAQUE",
"state": "NJ",
"postal_code": "074651016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1909 LONGFELLOW AVENUE",
"city": "THE BRONX",
"state": "NY",
"postal_code": "10460",
"telephone_number": "347-497-3998"
}
],
"practiceLocations": [
{
"address_1": "205 Conklintown Rd",
"address_purpose": "LOCATION",
"city": "Wanaque",
"state": "NJ",
"postal_code": "074652122",
"country_code": "US",
"telephone_number": "973-835-3900",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BURGESS",
"first_name": "RACHAEL",
"middle_name": "AVERY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-11",
"last_updated": "2020-12-11",
"certification_date": "2020-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NY",
"license": "10593-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in The Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.