Individual provider Active NPI

Chivaughn Martin

  • Registered Nurse
  • New York, NY
National Provider Identifier
1295047017
Registry record updated Jun 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
22660674 Issued in NY
Practice address
506 Malcolm X Blvd
New York, NY 10037-1802
Phone
(212) 939-1000
NPI assigned
Jul 9, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 294837 NY
Registered Nurse 163W00000X 22660674 NY Primary

Addresses

Primary practice location

506 Malcolm X Blvd
New York, NY 10037-1802

Mailing address

506 Malcolm X Blvd
New York, NY 10037-1802
Phone (718) 954-2884

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

LicenseStateTypeSpecialty
22660674NYMDRegistered Nurse
294837NYMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434931200000",
    "number": "1295047017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 MALCOLM X BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100371802",
            "telephone_number": "718-954-2884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 MALCOLM X BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100371802",
            "telephone_number": "212-939-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CHIVAUGHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-09",
        "last_updated": "2015-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "294837",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "22660674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; 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.