Active NPI
Dale Fredericks
- Specialist
- Brooklyn, NY
National Provider Identifier
1437700416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1364035191
- Practice address
- 152 E 39TH St Apt 2R
Brooklyn, NY 11203-2940 - Phone
- (516) 589-9777
- NPI assigned
- Sep 22, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Specialist | 174400000X | 1364035191 | NY | Primary |
Addresses
Primary practice location
152 E 39TH St Apt 2R
Brooklyn, NY 11203-2940
Mailing address
152 E 39TH St Apt 2R
Brooklyn, NY 11203-2940
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 |
|---|---|---|---|
| 1364035191 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621728000000",
"number": "1437700416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "152 E 39TH ST APT 2R",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112032940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "152 E 39TH ST APT 2R",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112032940",
"telephone_number": "516-589-9777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICKS",
"first_name": "DALE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-22",
"last_updated": "2021-05-23",
"certification_date": "2021-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "1364035191",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.