Active NPI
Diane Theresa Mihailovich, COTA
- Community Health Worker
- Commack, NY
National Provider Identifier
1093025454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 006656-1
- Practice address
- 29 Pinewood Dr
Commack, NY 11725-5612 - Phone
- (631) 499-1234
- NPI assigned
- Oct 19, 2010
- Last updated
- Oct 28, 2010
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 006656-1 | NY | Primary |
Addresses
Primary practice location
29 Pinewood Dr
Commack, NY 11725-5612
Mailing address
29 Pinewood Dr
Commack, NY 11725-5612
Phone (631) 499-1234
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 |
|---|---|---|---|
| 006656-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288224000000",
"number": "1093025454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 PINEWOOD DR",
"city": "COMMACK",
"state": "NY",
"postal_code": "117255612",
"telephone_number": "631-499-1234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29 PINEWOOD DR",
"city": "COMMACK",
"state": "NY",
"postal_code": "117255612",
"telephone_number": "631-499-1234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIHAILOVICH",
"first_name": "DIANE",
"middle_name": "THERESA",
"name_prefix": "Mrs.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-19",
"last_updated": "2010-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NY",
"license": "006656-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Commack, NY
- Michelle B Rogers LLC
- Michelle Hershkowitz, SLP. PC
- Michelle Listens LCSW, PC
- Mid Suffolk Speech Pathology & Swallowing Disorder Services of L.I., P
- Mid-Suffolk Medical Care PC (Island Medical Care)
- James Milano, M.D.
- Maria Clare Milazzo, PNP
- Calle Maran Milback, NP
- Bradley J Miller
- David M Miller, D.D.S
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.