Individual provider Active NPI

Robert Penaskovic, MSW

  • Clinical Social Worker
  • Mineola, NY
National Provider Identifier
1538155189
Registry record updated Aug 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
PRO14573-1 Issued in NY
Practice address
1517 Franklin Ave
205
Mineola, NY 11501-4804
Phone
(516) 746-3203
NPI assigned
Sep 20, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X PRO14573-1 NY Primary

Addresses

Primary practice location

1517 Franklin Ave
205
Mineola, NY 11501-4804

Mailing address

1517 Franklin Ave
205
Mineola, NY 11501-4804
Phone (516) 746-3203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101027001465 NY Practitioner - Clinical Social Worker 5092909614 Practice locations: Westbury, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

334 Trotting Lane
Westbury, NY 11590-6616

334 Trotting LN
BLDG 22
Westbury, NY 11590-6616
Phone (516) 636-9298

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PRO14573-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Elizabeth McGreal, LCSW Clinical PastSince Jun 6, 2021 Accepting new patients

Organizations & group practices 1

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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281052800000",
    "number": "1538155189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1517 FRANKLIN AVE",
            "address_2": "205",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014804",
            "telephone_number": "516-746-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1517 FRANKLIN AVE",
            "address_2": "205",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014804",
            "telephone_number": "516-746-3203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENASKOVIC",
        "first_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2010-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "PRO14573-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.