Active NPI
Liz S Dejesus, RN
- Methadone Clinic
- Valley Cottage, NY
National Provider Identifier
1447761648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Methadone Clinic
- License
- 703033
- Practice address
- 706 Executive Blvd Ste D
Valley Cottage, NY 10989-2039 - Phone
- (845) 362-3904
- NPI assigned
- Oct 16, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | 703033 | NY | Primary |
Addresses
Primary practice location
706 Executive Blvd Ste D
Valley Cottage, NY 10989-2039
Mailing address
12 High Ridge Rd
Stony Point, NY 10980-2710
Phone (646) 271-0750
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 |
|---|---|---|---|
| 703033 | NY | MD | Methadone Clinic |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508112000000",
"number": "1447761648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 HIGH RIDGE RD",
"city": "STONY POINT",
"state": "NY",
"postal_code": "109802710",
"telephone_number": "646-271-0750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "706 EXECUTIVE BLVD STE D",
"city": "VALLEY COTTAGE",
"state": "NY",
"postal_code": "109892039",
"telephone_number": "845-362-3904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEJESUS",
"first_name": "LIZ",
"middle_name": "S",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-16",
"last_updated": "2017-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "261QM2800X",
"taxonomy_group": "",
"desc": "Clinic/Center, Methadone",
"state": "NY",
"license": "703033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Cottage, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.