Active NPI
Serge Fenelon
- Physical Medicine & Rehabilitation Physician
- Brooklyn, NY
National Provider Identifier
1124459722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 124667
- Practice address
- 527 E 24TH St
Brooklyn, NY 11210-1129 - Phone
- (718) 434-0825
- NPI assigned
- Dec 6, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 124667 | NY | |
| Physical Medicine & Rehabilitation Physician | 208100000X | 124667 | NY | Primary |
Addresses
Primary practice location
527 E 24TH St
Brooklyn, NY 11210-1129
Mailing address
527 E 24TH St
Brooklyn, NY 11210-1129
Phone (718) 434-0825
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 |
|---|---|---|---|
| 124667 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386288000000",
"number": "1124459722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "527 E 24TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112101129",
"telephone_number": "718-434-0825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "527 E 24TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112101129",
"telephone_number": "718-434-0825"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENELON",
"first_name": "SERGE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-12-06",
"last_updated": "2013-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "124667",
"primary": false
},
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "NY",
"license": "124667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.