Active NPI
Stephen Chase Fog, L.AC.
- Acupuncturist
- South Salem, NY
National Provider Identifier
1316720253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 007145
- Practice address
- 402 Oakridge CMNS
South Salem, NY 10590-2438 - Phone
- (203) 536-1081
- Fax
- (203) 966-6002
- NPI assigned
- Aug 15, 2023
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 007145 | NY | Primary |
Addresses
Primary practice location
402 Oakridge CMNS
South Salem, NY 10590-2438
Mailing address
402 Oakridge CMNS
South Salem, NY 10590-2438
Phone (203) 536-1081
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 |
|---|---|---|---|
| 007145 | NY | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692057600000",
"number": "1316720253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "402 OAKRIDGE CMNS",
"city": "SOUTH SALEM",
"state": "NY",
"postal_code": "105902438",
"telephone_number": "203-536-1081",
"fax_number": "203-966-6002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 OAKRIDGE CMNS",
"city": "SOUTH SALEM",
"state": "NY",
"postal_code": "105902438",
"telephone_number": "203-536-1081",
"fax_number": "203-966-6002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOG",
"first_name": "STEPHEN",
"middle_name": "CHASE",
"credential": "L.AC.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-08-15",
"last_updated": "2023-08-15",
"certification_date": "2023-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "NY",
"license": "007145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Salem, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.