Mark Reyes De Jesus, MS

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

8611 Whitney Ave
3M
Elmhurst, NY 11373-3668

Phone

(646) 651-3530

NPI assigned

Oct 24, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477267200000",
    "number": "1336690494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8611 WHITNEY AVENUE",
            "address_2": "3M",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113733636",
            "telephone_number": "646-651-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8611 WHITNEY AVE",
            "address_2": "3M",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113733668",
            "telephone_number": "646-651-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE JESUS",
        "first_name": "MARK",
        "middle_name": "REYES",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-24",
        "last_updated": "2016-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID",
            "identifier": "215600411",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Banewattie Singh Dayal, OT
• Maan Darisse Roxas Dayan, NP
• Glenn Aban Dayanan, RN
• Dharrian J De Castro, PT
• Kassandra Jaime De Guzman, PT
• Stephanie De la Rosa
• Jessica De Leon, NP
• Deborah Nicholls Dean, M.D.
• Padmaja Deb Roy
• Stacy Allison Debarros, P.A.C.

• Specialist in Elmhurst, NY
• Providers in Elmhurst, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2016; 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.