Active NPI
Randy Watson
- Physician Assistant
- Bronx, NY
National Provider Identifier
1396991824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 012651
- Practice address
- 130 W Kingsbridge Rd
Bronx, NY 10468-3904 - Phone
- (718) 584-9000
- Fax
- (718) 741-4285
- NPI assigned
- Aug 15, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 012651 | NY | Primary |
Addresses
Primary practice location
130 W Kingsbridge Rd
Bronx, NY 10468-3904
Mailing address
11311 76TH Rd Apt 3a
Forest Hills, NY 11375-6557
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 |
|---|---|---|---|
| 012651 | NY | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218758400000",
"number": "1396991824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11311 76TH RD APT 3A",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113756557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 W KINGSBRIDGE RD",
"city": "BRONX",
"state": "NY",
"postal_code": "104683904",
"telephone_number": "718-584-9000",
"fax_number": "718-741-4285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "RANDY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-15",
"last_updated": "2008-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "012651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.