Individual provider Active NPI

Jillian Tomblin

  • Speech-Language Pathologist
  • Staten Island, NY
National Provider Identifier
1295278091
Registry record updated Jan 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
026422-1 Issued in NY
Practice address
225 Cleveland Ave
Staten Island, NY 10308-3218
Phone
(718) 982-4700
NPI assigned
Nov 28, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 026422-1 NY Primary

Addresses

Primary practice location

225 Cleveland Ave
Staten Island, NY 10308-3218

Mailing address

635 Wainwright Ave
Staten Island, NY 10312-3740
Phone (718) 490-5070

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
026422-1NYMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484870400000",
    "number": "1295278091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 WAINWRIGHT AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103123740",
            "telephone_number": "718-490-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CLEVELAND AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103083218",
            "telephone_number": "718-982-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOMBLIN",
        "first_name": "JILLIAN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-28",
        "last_updated": "2017-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "026422-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.

Verify at the official NPI Registry.