Individual provider Active NPI

Chidinma Chisom Duru, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1538995998
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F406328-01 Issued in NY
Practice address
198 E 121St St FL 5
New York, NY 10035-3523
Phone
(917) 474-2968
Fax
(347) 222-3024
NPI assigned
Sep 12, 2024
Last updated
Apr 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F406328-01 NY Primary
Medical-Surgical Registered Nurse 163WM0705X 26NR22638700 NJ
Psychiatric/Mental Health Registered Nurse 163WP0808X 738786-01 NY

Addresses

Primary practice location

198 E 121St St FL 5
New York, NY 10035-3523

Mailing address

198 E 121St St FL 5
New York, NY 10035-3523
Phone (917) 474-2968

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250212000976 NY Practitioner - Nurse Practitioner 7618407206

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26NR22638700NJMDMedical-Surgical Registered Nurse
738786-01NYMDPsychiatric/Mental Health Registered Nurse
F406328-01NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Foundation of Tomorrow NP in Psychiatry PLLC Psychiatric/Mental Health PastSince Sep 1, 2024 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1726099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1538995998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "198 E 121ST ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100353523",
            "telephone_number": "917-474-2968",
            "fax_number": "347-222-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "198 E 121ST ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100353523",
            "telephone_number": "917-474-2968",
            "fax_number": "347-222-3024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURU",
        "first_name": "CHIDINMA CHISOM",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-12",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F406328-01",
            "primary": true
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "NJ",
            "license": "26NR22638700",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NY",
            "license": "738786-01",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.