Active NPI
Elaine Kazakis
- Clinical Nurse Specialist
- Fayetteville, NY
National Provider Identifier
1124266424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Nurse Specialist
- License
- 435398-1
- Practice address
- 4208 Medical Center Dr
Fayetteville, NY 13066-6642 - Phone
- (315) 329-7984
- NPI assigned
- Jan 26, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Nurse Specialist | 364S00000X | 435398-1 | NY | Primary |
Addresses
Primary practice location
4208 Medical Center Dr
Fayetteville, NY 13066-6642
Mailing address
105 Dewolfe Rd
Syracuse, NY 13224-2249
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 |
|---|---|---|---|
| 435398-1 | NY | MD | Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232928000000",
"number": "1124266424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 DEWOLFE RD",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132242249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4208 MEDICAL CENTER DR",
"city": "FAYETTEVILLE",
"state": "NY",
"postal_code": "130666642",
"telephone_number": "315-329-7984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAZAKIS",
"first_name": "ELAINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-26",
"last_updated": "2009-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "364S00000X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist",
"state": "NY",
"license": "435398-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.