Active NPI
Diana Jernigan-Breedy
- Specialist
- Coram, NY
National Provider Identifier
1356748826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 743044131
- Practice address
- 17 Wycomb PL
Coram, NY 11727-1043 - Phone
- (718) 309-3481
- NPI assigned
- Nov 29, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 743044131 | NY | Primary |
Addresses
Primary practice location
17 Wycomb PL
Coram, NY 11727-1043
Mailing address
17 Wycomb PL
Coram, NY 11727-1043
Phone (718) 309-3481
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 |
|---|---|---|---|
| 743044131 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479772800000",
"number": "1356748826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 WYCOMB PL",
"city": "CORAM",
"state": "NY",
"postal_code": "117271043",
"telephone_number": "718-309-3481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 WYCOMB PL",
"city": "CORAM",
"state": "NY",
"postal_code": "117271043",
"telephone_number": "718-309-3481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JERNIGAN-BREEDY",
"first_name": "DIANA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-11-29",
"last_updated": "2016-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "743044131",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coram, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 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.