Individual provider Active NPI

Joan M Clyne, LPN

  • Licensed Practical Nurse
  • Lindenhurst, NY
National Provider Identifier
1093151870
Registry record updated May 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
129670 Issued in NY
Practice address
155 S Clinton Ave
Lindenhurst, NY 11757-5121
Phone
(631) 226-4649
NPI assigned
May 20, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 129670 NY Primary

Addresses

Primary practice location

155 S Clinton Ave
Lindenhurst, NY 11757-5121

Mailing address

155 S Clinton Ave
Lindenhurst, NY 11757-5121
Phone (631) 226-4649

Other identifiers 1

IdentifierTypeStateIssuer
129670OtherNYNYS LPN

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

LicenseStateTypeSpecialty
129670NYMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369008000000",
    "number": "1093151870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 S CLINTON AVE",
            "city": "LINDENHURST",
            "state": "NY",
            "postal_code": "117575121",
            "telephone_number": "631-226-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 S CLINTON AVE",
            "city": "LINDENHURST",
            "state": "NY",
            "postal_code": "117575121",
            "telephone_number": "631-226-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLYNE",
        "first_name": "JOAN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-20",
        "last_updated": "2013-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "129670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LPN",
            "identifier": "129670",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lindenhurst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.