Active NPI
Modupe Buluro
- School Registered Nurse
- Rockaway Beach, NY
National Provider Identifier
1194480103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Registered Nurse
- License
- 618918-01
- Practice address
- 151 Beach 97TH St FL 1
Rockaway Beach, NY 11693-1323 - Phone
- (917) 232-2082
- NPI assigned
- Nov 4, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| School Registered Nurse | 163WS0200X | 618918-01 | NY | Primary |
Addresses
Primary practice location
151 Beach 97TH St FL 1
Rockaway Beach, NY 11693-1323
Mailing address
151 Beach 97TH St FL 1
Rockaway Beach, NY 11693-1323
Phone (917) 232-2082
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 707-704-115 | Other | NY | DRIVER LICENSE NUMBER |
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 |
|---|---|---|---|
| 618918-01 | NY | MD | School Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635984000000",
"number": "1194480103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 BEACH 97TH ST FL 1",
"city": "ROCKAWAY BEACH",
"state": "NY",
"postal_code": "116931323",
"telephone_number": "917-232-2082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 BEACH 97TH ST FL 1",
"city": "ROCKAWAY BEACH",
"state": "NY",
"postal_code": "116931323",
"telephone_number": "917-232-2082"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULURO",
"first_name": "MODUPE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-11-04",
"last_updated": "2021-11-04",
"certification_date": "2021-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "163WS0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, School",
"state": "NY",
"license": "618918-01",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER LICENSE NUMBER",
"identifier": "707-704-115",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockaway Beach, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.