Active NPI
Christopher Etienne
- Licensed Practical Nurse
- Elmhurst, NY
National Provider Identifier
1124698907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 335732
- Practice address
- 4825 92ND St
Elmhurst, NY 11373-4052 - Phone
- (929) 240-8996
- NPI assigned
- Jun 25, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 335732 | NY | Primary |
Addresses
Primary practice location
4825 92ND St
Elmhurst, NY 11373-4052
Mailing address
4825 92ND St
Elmhurst, NY 11373-4052
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 335732 | Medicaid | NY |
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 |
|---|---|---|---|
| 335732 | NY | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624579200000",
"number": "1124698907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4825 92ND ST",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113734052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4825 92ND ST",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113734052",
"telephone_number": "929-240-8996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETIENNE",
"first_name": "CHRISTOPHER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-25",
"last_updated": "2021-06-25",
"certification_date": "2021-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "335732",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "335732",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.