Active NPI
Robert Wunderman
- Peer Specialist
- Bronx, NY
National Provider Identifier
1518674191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- NYCPS-P-4518
- Practice address
- 750 Astor Ave
Bronx, NY 10467-9300 - Phone
- (718) 881-7600
- NPI assigned
- Nov 2, 2022
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | NYCPS-P-4518 | NY | Primary |
Addresses
Primary practice location
750 Astor Ave
Bronx, NY 10467-9300
Mailing address
750 Astor Ave
Bronx, NY 10467-9300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NYCPS-P-4518 | Other | NY | THE NY PEER SPECIALIST CERTIFICATION BOARD |
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 |
|---|---|---|---|
| NYCPS-P-4518 | NY | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667347200000",
"number": "1518674191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "750 ASTOR AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104679300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 ASTOR AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104679300",
"telephone_number": "718-881-7600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WUNDERMAN",
"first_name": "ROBERT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-02",
"last_updated": "2022-11-02",
"certification_date": "2022-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NY",
"license": "NYCPS-P-4518",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THE NY PEER SPECIALIST CERTIFICATION BOARD",
"identifier": "NYCPS-P-4518",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.