Individual provider Active NPI

Theresa Pelikan, THERESA PELIKAN

  • Speech-Language Pathologist
  • Point Lookout, NY
National Provider Identifier
1124273552
Registry record updated Nov 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
010023-1 Issued in NY
Practice address
66 Lido Blvd.
Point Lookout, NY 11569
Phone
(516) 897-7337
NPI assigned
Nov 26, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2008

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 010023-1 NY Primary

Addresses

Primary practice location

66 Lido Blvd.
Point Lookout, NY 11569

Mailing address

PO Box 722
66 Lido Blvd.
Point Lookout, NY 11569-0722
Phone (516) 897-7337

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
010023-1NYMDOptician

NPI Registry JSON

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

{
    "created_epoch": "1227657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227657600000",
    "number": "1124273552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 722",
            "address_2": "66 LIDO BLVD.",
            "city": "POINT LOOKOUT",
            "state": "NY",
            "postal_code": "115690722",
            "telephone_number": "516-897-7337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 LIDO BLVD.",
            "city": "POINT LOOKOUT",
            "state": "NY",
            "postal_code": "11569",
            "telephone_number": "516-897-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELIKAN",
        "first_name": "THERESA",
        "name_prefix": "Mrs.",
        "credential": "THERESA PELIKAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-11-26",
        "last_updated": "2008-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "010023-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Point Lookout, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2008; 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.