Individual provider Active NPI

Vikki Lynne Macintosh, LPN

  • Licensed Practical Nurse
  • Islip Terrace, NY
National Provider Identifier
1093225252
Registry record updated Oct 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
329027-1 Issued in NY
Practice address
60 Craig Rd
Islip Terrace, NY 11752-1920
Phone
(631) 513-1177
NPI assigned
Oct 2, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2017

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 329027-1 NY Primary

Addresses

Primary practice location

60 Craig Rd
Islip Terrace, NY 11752-1920

Mailing address

60 Craig Rd
Islip Terrace, NY 11752-1920
Phone (631) 513-1177

Other identifiers 1

IdentifierTypeStateIssuer
093572136MedicaidNY

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
329027-1NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1506902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506902400000",
    "number": "1093225252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 CRAIG RD",
            "city": "ISLIP TERRACE",
            "state": "NY",
            "postal_code": "117521920",
            "telephone_number": "631-513-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 CRAIG RD",
            "city": "ISLIP TERRACE",
            "state": "NY",
            "postal_code": "117521920",
            "telephone_number": "631-513-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACINTOSH",
        "first_name": "VIKKI",
        "middle_name": "LYNNE",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-02",
        "last_updated": "2017-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "329027-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "093572136",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Islip Terrace, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2017; 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.