Individual provider Active NPI

Gerard Pruziner, LCSW

  • Clinical Social Worker
  • Commack, NY
National Provider Identifier
1366522252
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R032212-1 Issued in NY
Practice address
101 Burton LN
Commack, NY 11725-1940
Phone
(631) 462-4419
Fax
(631) 462-5954
NPI assigned
Oct 16, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X R032212-1 NY Primary

Addresses

Primary practice location

101 Burton LN
Commack, NY 11725-1940

Mailing address

101 Burton LN
Commack, NY 11725-1940
Phone (631) 462-4419

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140509001971 NY Practitioner - Clinical Social Worker 5395978795 Practice locations: Commack, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

101 Burton LN
Commack, NY 11725-1940
Phone (631) 896-1102

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R032212-1NYMDClinical Social Worker

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366522252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BURTON LN",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117251940",
            "telephone_number": "631-462-4419",
            "fax_number": "631-462-5954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BURTON LN",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117251940",
            "telephone_number": "631-462-4419",
            "fax_number": "631-462-5954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUZINER",
        "first_name": "GERARD",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R032212-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Commack, NY

Sources for this page

Verify at the official NPI Registry.