Active NPI
Jean Laurent, PTA
- Specialist
- New York, NY
National Provider Identifier
1508088386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 005624-1
- Practice address
- 825 W End Ave
Suite 1a
New York, NY 10025-5349 - Phone
- (845) 564-9853
- Fax
- (845) 564-6974
- NPI assigned
- May 2, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 005624-1 | NY | Primary |
Addresses
Primary practice location
825 W End Ave
Suite 1a
New York, NY 10025-5349
Mailing address
825 W End Ave
Suite 1a
New York, NY 10025-5349
Phone (845) 564-9853
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005624-1 | Other | NY | PTA LICENSE |
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 |
|---|---|---|---|
| 005624-1 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508088386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 W END AVE",
"address_2": "SUITE 1A",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100255349",
"telephone_number": "845-564-9853",
"fax_number": "845-564-6974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 W END AVE",
"address_2": "SUITE 1A",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100255349",
"telephone_number": "845-564-9853",
"fax_number": "845-564-6974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAURENT",
"first_name": "JEAN",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "005624-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA LICENSE",
"identifier": "005624-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, 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.