Active NPI
Phoenix Padmore
- Student in an Organized Health Care Education/Training Program
- Brooklyn, NY
National Provider Identifier
1124810098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 921 E New York Ave
Brooklyn, NY 11203-1393 - Phone
- (718) 778-0485
- NPI assigned
- May 19, 2025
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
921 E New York Ave
Brooklyn, NY 11203-1393
Mailing address
2184 Fulton St Apt 4a
Brooklyn, NY 11233-3362
Phone (929) 313-4043
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756944000000",
"number": "1124810098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2184 FULTON ST APT 4A",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112333362",
"telephone_number": "929-313-4043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "921 E NEW YORK AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112031393",
"telephone_number": "718-778-0485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PADMORE",
"first_name": "PHOENIX",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-05-19",
"last_updated": "2025-09-04",
"certification_date": "2025-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"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 Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.