Individual provider Active NPI

Marissa Brooks, L.P.N

  • Licensed Practical Nurse
  • Mastic Beach, NY
National Provider Identifier
1366675175
Registry record updated Aug 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
296940-1 Issued in NY
Practice address
47 Whittier Dr
Mastic Beach, NY 11951-5110
Phone
(631) 764-5927
NPI assigned
Aug 26, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 296940-1 NY Primary

Addresses

Primary practice location

47 Whittier Dr
Mastic Beach, NY 11951-5110

Mailing address

47 Whittier Dr
Mastic Beach, NY 11951-5110
Phone (631) 764-5927

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
296940-1NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1251244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251244800000",
    "number": "1366675175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 WHITTIER DR",
            "city": "MASTIC BEACH",
            "state": "NY",
            "postal_code": "119515110",
            "telephone_number": "631-764-5927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 WHITTIER DR",
            "city": "MASTIC BEACH",
            "state": "NY",
            "postal_code": "119515110",
            "telephone_number": "631-764-5927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "MARISSA",
        "credential": "L.P.N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-26",
        "last_updated": "2009-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "296940-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mastic Beach, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2009; 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.