Active NPI
Mark Moodie, REGISTERED NURSE
- Registered Nurse
- Westbury, NY
National Provider Identifier
1194259911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 782493
- Practice address
- 871 Leonard Dr
Westbury, NY 11590-1454 - Phone
- (516) 647-0767
- NPI assigned
- Apr 18, 2017
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 782493 | NY | Primary |
Addresses
Primary practice location
871 Leonard Dr
Westbury, NY 11590-1454
Mailing address
871 Leonard Dr
Westbury, NY 11590-1454
Phone (516) 647-0767
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 |
|---|---|---|---|
| 782493 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492473600000",
"number": "1194259911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "871 LEONARD DR",
"city": "WESTBURY",
"state": "NY",
"postal_code": "115901454",
"telephone_number": "516-647-0767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "871 LEONARD DR",
"city": "WESTBURY",
"state": "NY",
"postal_code": "115901454",
"telephone_number": "516-647-0767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOODIE",
"first_name": "MARK",
"name_prefix": "Mr.",
"credential": "REGISTERED NURSE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-18",
"last_updated": "2017-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "782493",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westbury, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.