Individual provider Active NPI

John Edmund Pickering X

  • Speech-Language Pathologist
  • Albany, NY
National Provider Identifier
1104860980
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
008140 Issued in NY
Practice address
6 Executive Park Dr
Albany, NY 12203-3791
Phone
(518) 482-9111
Fax
(518) 482-6142
NPI assigned
Jun 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 008140 NY Primary

Addresses

Primary practice location

6 Executive Park Dr
Albany, NY 12203-3791

Mailing address

6 Executive Park Dr
Albany, NY 12203-3791
Phone (518) 482-9111

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
008140NYMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Capital Region Physical Therapy, PLLC PastSince Oct 23, 2006 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104860980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 EXECUTIVE PARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122033791",
            "telephone_number": "518-482-9111",
            "fax_number": "518-482-6142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 EXECUTIVE PARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122033791",
            "telephone_number": "518-482-9111",
            "fax_number": "518-482-6142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKERING",
        "first_name": "JOHN",
        "middle_name": "EDMUND",
        "name_suffix": "X",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "008140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.