Active NPI
Robyn McKenna, OTA
- Contractor
- Centereach, NY
National Provider Identifier
1487903050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 224Z00000X
- Practice address
- 67 Picket LN
Centereach, NY 11720-2510 - Phone
- (631) 943-0516
- NPI assigned
- Aug 29, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 224Z00000X | NY | Primary |
Addresses
Primary practice location
67 Picket LN
Centereach, NY 11720-2510
Mailing address
67 Picket LN
Centereach, NY 11720-2510
Phone (631) 943-0516
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 224Z00000X | Medicaid | NY |
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 |
|---|---|---|---|
| 224Z00000X | NY | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346198400000",
"number": "1487903050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "67 PICKET LN",
"city": "CENTEREACH",
"state": "NY",
"postal_code": "117202510",
"telephone_number": "631-943-0516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67 PICKET LN",
"city": "CENTEREACH",
"state": "NY",
"postal_code": "117202510",
"telephone_number": "631-943-0516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENNA",
"first_name": "ROBYN",
"credential": "OTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-29",
"last_updated": "2012-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "NY",
"license": "224Z00000X",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "224Z00000X",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Centereach, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.