Active NPI
Alicia Detomaso
- Registered Nurse
- Hauppauge, NY
National Provider Identifier
1073062071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 797314
- Practice address
- 220 Veterans Hwy
Hauppauge, NY 11788-2420 - Phone
- (516) 736-1588
- NPI assigned
- Oct 2, 2016
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 797314 | NY | Primary |
Addresses
Primary practice location
220 Veterans Hwy
Hauppauge, NY 11788-2420
Mailing address
4 Laramie CT
Coram, NY 11727-1514
Phone (631) 521-3483
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 |
|---|---|---|---|
| 797314 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724371200000",
"number": "1073062071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 LARAMIE CT",
"city": "CORAM",
"state": "NY",
"postal_code": "117271514",
"telephone_number": "631-521-3483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 VETERANS HWY",
"city": "HAUPPAUGE",
"state": "NY",
"postal_code": "117882420",
"telephone_number": "516-736-1588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETOMASO",
"first_name": "ALICIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-02",
"last_updated": "2024-08-23",
"certification_date": "2024-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "797314",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hauppauge, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.