Active NPI
Mavis Veronica Solomon
- Occupational Therapy Assistant
- Fresh Meadows, NY
National Provider Identifier
1285148866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 006411-1
- Practice address
- 15910 71St Ave Apt 6B
Fresh Meadows, NY 11365-3070 - Phone
- (917) 250-5557
- Fax
- (718) 591-1540
- NPI assigned
- Nov 19, 2017
- 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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 006411-1 | NY | Primary |
Addresses
Primary practice location
15910 71St Ave Apt 6B
Fresh Meadows, NY 11365-3070
Mailing address
15910 71St Ave Apt 6B
Fresh Meadows, NY 11365-3070
Phone (917) 250-5557
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 |
|---|---|---|---|
| 006411-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511049600000",
"number": "1285148866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15910 71ST AVE APT 6B",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113653070",
"telephone_number": "917-250-5557",
"fax_number": "718-591-1540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15910 71ST AVE APT 6B",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113653070",
"telephone_number": "917-250-5557",
"fax_number": "718-591-1540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOLOMON",
"first_name": "MAVIS",
"middle_name": "VERONICA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-19",
"last_updated": "2017-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapy Assistant",
"state": "NY",
"license": "006411-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresh Meadows, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.