Anthonia Ajimavo, NP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Bronx, NY
NPI 1114309283 · NPPES record last updated Aug 16, 2024
Key facts
- NPI
- 1114309283
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- F405705 (NY)
- Practice address
- 2604 3Rd Ave
Bronx, NY 10454-1199 - Phone
- (718) 292-0100
- NPI assigned
- Jun 24, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 10
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- North Shore-Lij Medical PC
Shakespeare Operating LLC
Essen Medical Associates, PC
Practice addresses (Care Compare)
101 Saint Andrews LN
Glen Cove, NY 11542-2254
Phone (631) 675-4550
1250 Shakespeare Ave
Bronx, NY 10452-3012
Phone (646) 350-1633
2015 Grand Ave
FL 1
Bronx, NY 10453-4611
Phone (718) 583-7736
300 Community Dr
Manhasset, NY 11030-3816
300 Community Dr LL
Manhasset, NY 11030-3816
Phone (516) 562-2229
330 Community Dr
Manhasset, NY 11030-3816
Phone (516) 708-2550
350 Community Dr
Manhasset, NY 11030-3816
Phone (516) 562-3845
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150908001225 | NY | Practitioner - Nurse Practitioner | 0143536045 | Reassigns benefits to 8 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F307288-1 | NY | MD | Adult Health Nurse Practitioner |
| F405705 | NY | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles (10 of 14)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shakespeare Operating LLC | Current |
Accepting new patients | |
| North Shore - Lij Medical PC | Current |
Accepting new patients | |
| Essen Medical Urgicare, PLLC | Current |
Accepting new patients | |
| House Call Medical Services of New York, PLLC | Current |
Accepting new patients | |
| Essen Medical Associates, PC | Current |
Accepting new patients | |
| Essen Medical Associates, PC | Current |
Accepting new patients | |
| Parkway Pain Care & Rehabilitation P.C. | Current |
Accepting new patients | |
| Bronx Medical Practice P.C. | Current |
Accepting new patients | |
| Serenity Integrative Services NP in Psychiatry PC | Psychiatric/Mental Health | Current | Accepting new patients |
| North Shore-Lij Medical PC | Current |
Accepting new patients |
Locations
1250 Shakespeare Ave
Bronx, NY 10452
Phone (646) 350-1633
2015 Grand Concourse
Bronx, NY 10453
Phone (718) 294-6200
1371 Seabury Ave
Bronx, NY 10461
Phone (718) 294-6200
2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400
1550 Dr Martin L King Jr Blvd
Bronx, NY 10452
Phone (347) 269-2366
4303 14th Ave
Brooklyn, NY 11219
Phone (718) 436-7800
101 Saint Andrews Ln
Fl 1
Glen Cove, NY 11542
Phone (516) 674-1812
8989 Union Tpke
Glendale, NY 11385
Phone (718) 480-6207
8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400
300 Community Dr
Plandome, NY 11030
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | F307288-1 | NY | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | F405705 | NY | Yes |
Addresses
Primary practice location
2604 3Rd Ave
Bronx, NY 10454-1199
Mailing address
2604 3Rd Ave
Bronx, NY 10454-1199
Phone (718) 292-0100
Other providers in Bronx, NY
- Nora Ajdir
- Narjiss Aji
- Opeyemi Ajibade
- Damola Gani Ajibola
- Olorunfemi Emmanuel Ajikan
- Festus Ajisogun
- Mukesh H Ajmera
- Modinatu Ajomagberin
- Muibat Ajomagberin
- Ajp Psychotherapy
All providers in Bronx, NY · Psychiatric/Mental Health Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.