NPIMap

Organization Active NPI

Jerome Street Clinic

  • Community/Behavioral Health Agency
  • Brooklyn, NY
National Provider Identifier
1164555801
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
JEROME STREET CLINIC
Practice address
971 Jerome St
Brooklyn, NY 11207-9252
Phone
(718) 272-3300
NPI assigned
Mar 13, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Peter Campanelli, PSY.D.NPI 1164545489
Title
Ceo
Phone
(212) 385-3030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

971 Jerome St
Brooklyn, NY 11207-9252

Mailing address

971 Jerome St
Brooklyn, NY 11207-9252
Phone (718) 272-3300

Other identifiers 1

IdentifierTypeStateIssuer
01551404MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Icl Bronx Park East35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164555801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "971 JEROME ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112079252",
            "telephone_number": "718-272-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 JEROME ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112079252",
            "telephone_number": "718-272-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEROME STREET CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CAMPANELLI",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "212-385-3030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01551404",
            "state": "NY"
        }
    ],
    "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.