NPIMap

Organization Active NPI

Self Employed

  • Skilled Nursing Facility
  • Mastic Beach, NY
National Provider Identifier
1033582291
Registry record updated Nov 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
705976-1 Issued in NY
Legal business name
SELF EMPLOYED
Practice address
74 Mill Dr
Mastic Beach, NY 11951-1403
Phone
(631) 599-8372
NPI assigned
Nov 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Kaitlyn SymancykNPI 1518326487
Title
Registered Nurse
Phone
(631) 235-8057

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 705976-1 NY Primary

Addresses

Primary practice location

74 Mill Dr
Mastic Beach, NY 11951-1403

Mailing address

67 Radburn Dr
Farmingville, NY 11738-1046

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447027200000",
    "number": "1033582291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 RADBURN DR",
            "city": "FARMINGVILLE",
            "state": "NY",
            "postal_code": "117381046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 MILL DR",
            "city": "MASTIC BEACH",
            "state": "NY",
            "postal_code": "119511403",
            "telephone_number": "631-599-8372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF EMPLOYED",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-09",
        "last_updated": "2015-11-09",
        "status": "A",
        "authorized_official_last_name": "SYMANCYK",
        "authorized_official_first_name": "KAITLYN",
        "authorized_official_title_or_position": "REGISTERED NURSE",
        "authorized_official_telephone_number": "631-235-8057",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "705976-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mastic Beach, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.