Fenol Christopher Larock II

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

104100000X Issued in NY

Practice address

497 Rockaway Ave
Valley Stream, NY 11581-1909

Phone

(718) 845-2621

Fax

(718) 845-2622

NPI assigned

Aug 3, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1722643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722643200000",
    "number": "1326878596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 KIRKBY RD",
            "city": "ELMONT",
            "state": "NY",
            "postal_code": "110033523",
            "telephone_number": "516-853-1609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "497 ROCKAWAY AVE",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115811909",
            "telephone_number": "718-845-2621",
            "fax_number": "718-845-2622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAROCK",
        "first_name": "FENOL",
        "middle_name": "CHRISTOPHER",
        "name_suffix": "II",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-08-03",
        "last_updated": "2024-08-03",
        "certification_date": "2024-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NY",
            "license": "104100000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peer Specialist in Valley Stream, NY
• Providers in Valley Stream, NY by specialty
• Peer Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2024; 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.