Active NPI
Timothy Ezadhe
- Licensed Practical Nurse
- Staten Island, NY
National Provider Identifier
1053684340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 306157-1
- Practice address
- 151 Jersey St
Apt.1D
Staten Island, NY 10301-1464 - Phone
- (347) 785-3270
- NPI assigned
- Feb 16, 2012
- 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 306157-1 | NY | Primary |
Addresses
Primary practice location
151 Jersey St
Apt.1D
Staten Island, NY 10301-1464
Mailing address
151 Jersey Street
Apt.1D
Staten Island, NY 10301
Phone (347) 785-3270
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 |
|---|---|---|---|
| 306157-1 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329350400000",
"number": "1053684340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 JERSEY STREET",
"address_2": "APT.1D",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "10301",
"telephone_number": "347-785-3270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 JERSEY ST",
"address_2": "APT.1D",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103011464",
"telephone_number": "347-785-3270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZADHE",
"first_name": "TIMOTHY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-16",
"last_updated": "2012-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "306157-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.