Active NPI
Tache Ebony Star Gorton
- Licensed Practical Nurse
- Bloomingburg, NY
National Provider Identifier
1306518626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 33303701
- Practice address
- 25 Aspen Drive
Bloomingburg, NY 12721 - Phone
- (845) 249-9646
- NPI assigned
- Oct 5, 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 33303701 | NY | Primary |
Addresses
Primary practice location
25 Aspen Drive
Bloomingburg, NY 12721
Mailing address
25 Aspen Drive
Bloomingburg, NY 12721
Phone (845) 249-9646
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Bloomingburg | Health Information Exchange (HIE) |
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 |
|---|---|---|---|
| 33303701 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633392000000",
"number": "1306518626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 ASPEN DRIVE",
"city": "BLOOMINGBURG",
"state": "NY",
"postal_code": "12721",
"telephone_number": "845-249-9646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 ASPEN DRIVE",
"city": "BLOOMINGBURG",
"state": "NY",
"postal_code": "12721",
"telephone_number": "845-249-9646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORTON",
"first_name": "TACHE",
"middle_name": "EBONY STAR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-05",
"last_updated": "2021-10-05",
"certification_date": "2021-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "33303701",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Bloomingburg",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"address_1": "25 Aspen Drive",
"city": "Bloomingburg",
"state": "NY",
"country_code": "US",
"postal_code": "12721",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bloomingburg, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.