Active NPI
Theresa Reyes Custodio, RN
- Pediatric Registered Nurse
- Yonkers, NY
National Provider Identifier
1508162397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Registered Nurse
- License
- 608387-1
- Practice address
- 1 Pier Pointe St
Apt 517
Yonkers, NY 10701-6941 - Phone
- (774) 888-7724
- NPI assigned
- Jan 27, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Registered Nurse | 163WH0200X | 608387-1 | NY | |
| Pediatric Registered Nurse | 163WP0200X | 608387-1 | NY | Primary |
Addresses
Primary practice location
1 Pier Pointe St
Apt 517
Yonkers, NY 10701-6941
Mailing address
1 Pier Pointe St
Apt 517
Yonkers, NY 10701-3569
Phone (774) 888-7724
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 |
|---|---|---|---|
| 608387-1 | NY | MD | Home Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296086400000",
"number": "1508162397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 PIER POINTE ST",
"address_2": "APT 517",
"city": "YONKERS",
"state": "NY",
"postal_code": "107013569",
"telephone_number": "774-888-7724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 PIER POINTE ST",
"address_2": "APT 517",
"city": "YONKERS",
"state": "NY",
"postal_code": "107016941",
"telephone_number": "774-888-7724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSTODIO",
"first_name": "THERESA",
"middle_name": "REYES",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-27",
"last_updated": "2011-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "163WH0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Home Health",
"state": "NY",
"license": "608387-1",
"primary": false
},
{
"code": "163WP0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Pediatrics",
"state": "NY",
"license": "608387-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yonkers, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.