Active NPI
Samuel Pellegrino Connors, MS, OTR/L
- Occupational Therapist
- Baldwin, NY
National Provider Identifier
1194312157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 025255
- Practice address
- 2930 Verity LN
Baldwin, NY 11510-4552 - Phone
- (516) 946-2057
- NPI assigned
- Dec 24, 2020
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 025255 | NY | Primary |
Addresses
Primary practice location
2930 Verity LN
Baldwin, NY 11510-4552
Mailing address
2930 Verity LN
Baldwin, NY 11510-4552
Phone (516) 946-2057
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025255 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608768000000",
"number": "1194312157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2930 VERITY LN",
"city": "BALDWIN",
"state": "NY",
"postal_code": "115104552",
"telephone_number": "516-946-2057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2930 VERITY LN",
"city": "BALDWIN",
"state": "NY",
"postal_code": "115104552",
"telephone_number": "516-946-2057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLEGRINO CONNORS",
"first_name": "SAMUEL",
"name_prefix": "Mr.",
"credential": "MS, OTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-24",
"last_updated": "2020-12-24",
"certification_date": "2020-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "025255",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baldwin, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 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.