Active NPI
Nicole Hagan
- Speech-Language Pathologist
- Woodside, NY
National Provider Identifier
1093149676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 024019
- Practice address
- 42-00 72ND Street
Nyc Department of Education- P.S. 12
Woodside, NY 11377 - Phone
- (516) 395-9134
- NPI assigned
- Aug 30, 2013
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 024019 | NY | Primary |
Addresses
Primary practice location
42-00 72ND Street
Nyc Department of Education- P.S. 12
Woodside, NY 11377
Mailing address
456 Spruce LN
East Meadow, NY 11554-3704
Phone (516) 395-9134
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 |
|---|---|---|---|
| 024019 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598227200000",
"number": "1093149676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "456 SPRUCE LN",
"city": "EAST MEADOW",
"state": "NY",
"postal_code": "115543704",
"telephone_number": "516-395-9134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42-00 72ND STREET",
"address_2": "NYC DEPARTMENT OF EDUCATION- P.S. 12",
"city": "WOODSIDE",
"state": "NY",
"postal_code": "11377",
"telephone_number": "516-395-9134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGAN",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-30",
"last_updated": "2020-08-24",
"certification_date": "2020-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "024019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.