Individual provider Active NPI

Avianne Waithe, D.C.

  • Chiropractor
  • Jackson Heights, NY
National Provider Identifier
1518366376
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
38MC00711200 Issued in NJ
Practice address
3723 72ND St FL 1
Jackson Heights, NY 11372-6126
Phone
(443) 622-9429
Fax
(888) 573-3898
NPI assigned
Aug 18, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Chiropractor 111NN1001X 38MC00711200 NJ
Pediatric Chiropractor 111NP0017X 38MC00711200 NJ
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X X013232 NY
Chiropractor 111N00000X 38MC00711200 NJ Primary

Addresses

Primary practice location

3723 72ND St FL 1
Jackson Heights, NY 11372-6126

Mailing address

3723 72ND St FL 1
Jackson Heights, NY 11372-6126
Phone (443) 622-9429

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

LicenseStateTypeSpecialty
X013232NYMDRehabilitation Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
New York Injury Chiropractic Rehab PC Rehabilitation CurrentSince Apr 28, 2024 Accepting new patients
New York Injury Chiropractic Rehab PC Rehabilitation Current Accepting new patients
Vitamed Family Practice Multi-Specialty Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1408320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1518366376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3723 72ND ST FL 1",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113726126",
            "telephone_number": "443-622-9429",
            "fax_number": "888-573-3898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3723 72ND ST FL 1",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113726126",
            "telephone_number": "443-622-9429",
            "fax_number": "888-573-3898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAITHE",
        "first_name": "AVIANNE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-18",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "NJ",
            "license": "38MC00711200",
            "primary": false
        },
        {
            "code": "111NP0017X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "state": "NJ",
            "license": "38MC00711200",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "NY",
            "license": "X013232",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00711200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; 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.