Individual provider Active NPI

James Waller, L.AC, LMT

  • Acupuncturist
  • Hicksville, NY
National Provider Identifier
1346643376
Registry record updated Oct 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
004890 Issued in NY
Practice address
80 Vincent Rd
Hicksville, NY 11801-1927
Phone
(646) 220-3133
NPI assigned
Oct 5, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X 004890 NY Primary

Addresses

Primary practice location

80 Vincent Rd
Hicksville, NY 11801-1927

Mailing address

80 Vincent Rd
Hicksville, NY 11801-1927
Phone (646) 220-3133

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

LicenseStateTypeSpecialty
004890NYMDAcupuncturist

NPI Registry JSON

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

{
    "created_epoch": "1412467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412467200000",
    "number": "1346643376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 VINCENT RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118011927",
            "telephone_number": "646-220-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 VINCENT RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118011927",
            "telephone_number": "646-220-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "JAMES",
        "credential": "L.AC, LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-05",
        "last_updated": "2014-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "004890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hicksville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2014; 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.