Active NPI
Renaldo Stover
- Social Worker
- Bronx, NY
National Provider Identifier
1053089649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 094569-01
- Practice address
- 3517 E Tremont Ave
Bronx, NY 10465-2002 - Phone
- (718) 792-4178
- Fax
- (718) 792-2496
- NPI assigned
- Aug 31, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 094569-01 | NY | Primary |
Addresses
Primary practice location
3517 E Tremont Ave
Bronx, NY 10465-2002
Mailing address
3517 E Tremont Ave
Bronx, NY 10465-2002
Phone (718) 792-4178
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 |
|---|---|---|---|
| 094569-01 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630368000000",
"number": "1053089649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3517 E TREMONT AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104652002",
"telephone_number": "718-792-4178",
"fax_number": "718-792-2496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3517 E TREMONT AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104652002",
"telephone_number": "718-792-4178",
"fax_number": "718-792-2496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOVER",
"first_name": "RENALDO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-08-31",
"last_updated": "2021-08-31",
"certification_date": "2021-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "094569-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.