Active NPI
Peter Edward Jerabeck, OTR
- Occupational Therapist
- Staten Island, NY
National Provider Identifier
1477619716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1705
- Practice address
- 11 Ralph Place
Suite 111
Staten Island, NY 10304 - Phone
- (718) 447-0733
- Fax
- (718) 447-2423
- NPI assigned
- Dec 29, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1705 | NY | Primary |
Addresses
Primary practice location
11 Ralph Place
Suite 111
Staten Island, NY 10304
Mailing address
11 Ralph Place
Suite 111
Staten Island, NY 10304
Phone (718) 447-0733
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160897 | Other | NY | ELDERPLAN |
| 19868P | Other | NY | HIP |
| 4C2101 | Other | NY | HEALTH NET |
| OS165 | Other | NY | OXFORD |
| 014290 | Other | NY | GROUP HEALTH INC |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1705 | NM | MD | Chiropractor |
| 1705 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477619716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 RALPH PLACE",
"address_2": "SUITE 111",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "10304",
"telephone_number": "718-447-0733",
"fax_number": "718-447-2423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 RALPH PLACE",
"address_2": "SUITE 111",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "10304",
"telephone_number": "718-447-0733",
"fax_number": "718-447-2423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JERABECK",
"first_name": "PETER",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "1705",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ELDERPLAN",
"identifier": "160897",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP",
"identifier": "19868P",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET",
"identifier": "4C2101",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "OS165",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP HEALTH INC",
"identifier": "014290",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.