Justin Derek Harbst, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

002123 Issued in NY

Practice address

90 E Shore Rd
Great Neck, NY 11023-2409

Phone

(516) 684-1122

NPI assigned

Oct 31, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1351641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351641600000",
    "number": "1497009369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2557 14TH ST APT 1",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111023720",
            "telephone_number": "607-821-8421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 E SHORE RD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110232409",
            "telephone_number": "516-684-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARBST",
        "first_name": "JUSTIN",
        "middle_name": "DEREK",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-31",
        "last_updated": "2012-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "002123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.

Verify at the official NPI Registry.