Individual provider Active NPI

Jessica Gibson, BC HAD

  • Hearing Instrument Specialist
  • New Hyde Park, NY
National Provider Identifier
1407478464
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing Instrument SpecialistTaxonomy code 237700000X
License
14000061292 Issued in NY
Practice address
1300 Union Tpke Ste 103a
New Hyde Park, NY 11040-1759
Phone
(516) 588-6742
NPI assigned
May 13, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing Instrument Specialist 237700000X 14000061292 NY Primary

Addresses

Primary practice location

1300 Union Tpke Ste 103a
New Hyde Park, NY 11040-1759

Mailing address

11818 199TH St
Saint Albans, NY 11412-3430
Phone (337) 274-3670

Other practice location 1

30 Merrick Ave Ste 109
East Meadow, NY 11554-1580
Phone (516) 260-5950

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
14000061292NYMDHearing Instrument Specialist

NPI Registry JSON

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

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1407478464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11818 199TH ST",
            "city": "SAINT ALBANS",
            "state": "NY",
            "postal_code": "114123430",
            "telephone_number": "337-274-3670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 UNION TPKE STE 103A",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401759",
            "telephone_number": "516-588-6742"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 Merrick Ave Ste 109",
            "address_purpose": "LOCATION",
            "city": "East Meadow",
            "state": "NY",
            "postal_code": "115541580",
            "country_code": "US",
            "telephone_number": "516-260-5950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JESSICA",
        "credential": "BC HAD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-13",
        "last_updated": "2021-08-04",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "NY",
            "license": "14000061292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Hyde Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.