Individual provider Active NPI

Fnu Rooble, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Binghamton, NY
National Provider Identifier
1164127767
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1042 Mitchell Ave # 42
Binghamton, NY 13903-1678
Phone
(607) 772-8772
NPI assigned
Apr 3, 2023
Reactivated
Nov 21, 2023
Last updated
Jun 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MT228664 PA
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1042 Mitchell Ave # 42
Binghamton, NY 13903-1678

Mailing address

10-42 Mitchell Ave Ste 1000
Binghamton, NY 13903-1617
Phone (607) 772-8772

Other identifiers 1

IdentifierTypeStateIssuer
MT228664OtherPATRAINING LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240130003404 PA Order and Referring Only - PsychiatryPractitioner - Psychiatry 7214380872

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
The Wright Center Medical Group Psychiatry PastSince Apr 1, 2023 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1680480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1164127767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10-42 MITCHELL AVE STE 1000",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139031617",
            "telephone_number": "607-772-8772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1042 MITCHELL AVE # 42",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139031678",
            "telephone_number": "607-772-8772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOBLE",
        "first_name": "FNU",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-03",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "deactivation_date": "2023-11-06",
        "reactivation_date": "2023-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MT228664",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAINING LICENSE",
            "identifier": "MT228664",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Binghamton, NY

Sources for this page

Verify at the official NPI Registry.