Active NPI
Charles Durrell Clayton, DPM
- Podiatrist
- Mastic, NY
National Provider Identifier
1336205103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- N004021
- Practice address
- 152 N Titmus Dr
Mastic, NY 11950-1818 - Phone
- (631) 871-6945
- NPI assigned
- Dec 28, 2006
- 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | N004021 | NY | Primary |
Addresses
Primary practice location
152 N Titmus Dr
Mastic, NY 11950-1818
Mailing address
152 N Titmus Dr
Mastic, NY 11950-1818
Phone (631) 871-6945
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00910178 | Medicaid | NY |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N004021 | NY | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336205103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "152 N TITMUS DR",
"city": "MASTIC",
"state": "NY",
"postal_code": "119501818",
"telephone_number": "631-871-6945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "152 N TITMUS DR",
"city": "MASTIC",
"state": "NY",
"postal_code": "119501818",
"telephone_number": "631-871-6945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLAYTON",
"first_name": "CHARLES",
"middle_name": "DURRELL",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NY",
"license": "N004021",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00910178",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mastic, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.