Organization Active NPI

Living Water NP in Family Health PLLC

  • Nurse Practitioner
  • Valley Stream, NY
National Provider Identifier
1033732698
Registry record updated May 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
LIVING WATER NP IN FAMILY HEALTH PLLC
Practice address
78 Margaret Dr
Valley Stream, NY 11580-1741
Phone
(917) 513-7462
NPI assigned
May 18, 2020
Last updated
May 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2020

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

Authorized official

Name
Ms. Esther RomilusNPI 1073954897
Title
Family Nurse Practitioner
Phone
(917) 513-7462

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
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

78 Margaret Dr
Valley Stream, NY 11580-1741

Mailing address

78 Margaret Dr
Valley Stream, NY 11580-1741
Phone (917) 513-7462

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200916000004 NY Part B Supplier - Clinic/Group Practice 0042638553 Receives reassigned benefits from 1 practitioner
Practice locations: Valley Stream, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589760000000",
    "number": "1033732698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 MARGARET DR",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115801741",
            "telephone_number": "917-513-7462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 MARGARET DR",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115801741",
            "telephone_number": "917-513-7462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WATER NP IN FAMILY HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-18",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A",
        "authorized_official_last_name": "ROMILUS",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "917-513-7462",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.