Active NPI
Jason Andrew Wolk, RN
- Pediatric Registered Nurse
- Manorville, NY
National Provider Identifier
1407013477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Registered Nurse
- License
- 528454-1
- Practice address
- 26 Winding Path Apt 15
Manorville, NY 11949-2258 - Phone
- (516) 987-6607
- NPI assigned
- May 19, 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 |
|---|---|---|---|---|
| Pediatric Registered Nurse | 163WP0200X | 528454-1 | NY | Primary |
Addresses
Primary practice location
26 Winding Path Apt 15
Manorville, NY 11949-2258
Mailing address
26 Winding Path Apt 15
Manorville, NY 11949-2258
Phone (516) 987-6607
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02365731 | Medicaid | NY |
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 528454-1 | NY | MD | Pediatric Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1407013477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 WINDING PATH APT 15",
"city": "MANORVILLE",
"state": "NY",
"postal_code": "119492258",
"telephone_number": "516-987-6607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 WINDING PATH APT 15",
"city": "MANORVILLE",
"state": "NY",
"postal_code": "119492258",
"telephone_number": "516-987-6607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLK",
"first_name": "JASON",
"middle_name": "ANDREW",
"name_prefix": "Mr.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-19",
"last_updated": "2008-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Pediatrics",
"state": "NY",
"license": "528454-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02365731",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manorville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.