Active NPI
Gretta Belton-Bourjolly, SLP
- Speech-Language Pathologist
- Jamaica, NY
National Provider Identifier
1376795831
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 009151
- Practice address
- 11714 170TH St
Jamaica, NY 11434-2212 - Phone
- (718) 527-0362
- Fax
- (718) 527-0362
- NPI assigned
- Oct 16, 2008
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 009151 | NY | Primary |
Addresses
Primary practice location
11714 170TH St
Jamaica, NY 11434-2212
Mailing address
11714 170TH St
Jamaica, NY 11434-2212
Phone (718) 527-0362
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 |
|---|---|---|---|
| 009151 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224115200000",
"number": "1376795831",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11714 170TH ST",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114342212",
"telephone_number": "718-527-0362",
"fax_number": "718-527-0362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11714 170TH ST",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114342212",
"telephone_number": "718-527-0362",
"fax_number": "718-527-0362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BELTON-BOURJOLLY",
"first_name": "GRETTA",
"name_prefix": "Mrs.",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-16",
"last_updated": "2008-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "009151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.