Active NPI
Andrew James Fairley, CRPA
- Peer Specialist
- Staten Island, NY
National Provider Identifier
1144819673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- CRPA-P-4690
- Practice address
- 96 Mobile Ave
Staten Island, NY 10306-2128 - Phone
- (347) 756-0787
- NPI assigned
- Jan 11, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | CRPA-P-4690 | NY | Primary |
Addresses
Primary practice location
96 Mobile Ave
Staten Island, NY 10306-2128
Mailing address
96 Mobile Ave
Staten Island, NY 10306-2128
Phone (347) 756-0787
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 |
|---|---|---|---|
| CRPA-P-4690 | NY | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610323200000",
"number": "1144819673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "96 MOBILE AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103062128",
"telephone_number": "347-756-0787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "96 MOBILE AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103062128",
"telephone_number": "347-756-0787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRLEY",
"first_name": "ANDREW",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "CRPA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-01-11",
"last_updated": "2021-01-11",
"certification_date": "2021-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Peer Specialist",
"state": "NY",
"license": "CRPA-P-4690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.