Pauline Black

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F347080 Issued in NY

Practice address

2015 Grand Concourse
Bronx, NY 10453-4303

Phone

(718) 299-7295

Fax

(718) 299-6797

NPI assigned

Mar 3, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1427682111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1434 WILLIAMSBRIDGE RD FL 2",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612507",
            "telephone_number": "718-618-0401",
            "fax_number": "347-479-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104534303",
            "telephone_number": "718-299-7295",
            "fax_number": "718-299-6797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "PAULINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-03",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95013098",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F347080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latondra M Black-Graham, LMSW
• Eucilda Black
• Heather Marie Black, PHARM D
• Irwin Michael Black, LCSWR 041213 NYS
• Kristel Victoria Black, MD
• Simone Black
• Felice Blackledge
• Christina Blackman
• Dana Blackman
• Michelle A Blackmore, PHD

• Family Nurse Practitioner in Bronx, NY
• Providers in Bronx, NY by specialty
• Family Nurse Practitioner in New York

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