Active NPI
Nicole Stack
- Occupational Therapist
- Suffern, NY
National Provider Identifier
1548645443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 016527
- Practice address
- 255 Lafayette Ave
Suffern, NY 10901-4812 - Phone
- (845) 368-5000
- NPI assigned
- Jul 21, 2015
- Last updated
- Jul 21, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 016527 | NY | Primary |
Addresses
Primary practice location
255 Lafayette Ave
Suffern, NY 10901-4812
Mailing address
255 Lafayette Ave
Suffern, NY 10901-4812
Phone (845) 368-5000
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 |
|---|---|---|---|
| 016527 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437436800000",
"number": "1548645443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "255 LAFAYETTE AVE",
"city": "SUFFERN",
"state": "NY",
"postal_code": "109014812",
"telephone_number": "845-368-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 LAFAYETTE AVE",
"city": "SUFFERN",
"state": "NY",
"postal_code": "109014812",
"telephone_number": "845-368-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACK",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-21",
"last_updated": "2015-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "016527",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suffern, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.