Active NPI
Laurajean Basile
- Licensed Practical Nurse
- Port Jefferson Station, NY
National Provider Identifier
1578642286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 263269-1
- Practice address
- 5 Continental Dr
Port Jefferson Station, NY 11776-4211 - Phone
- (631) 828-6021
- NPI assigned
- Nov 3, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 263269-1 | NY | Primary |
Addresses
Primary practice location
5 Continental Dr
Port Jefferson Station, NY 11776-4211
Mailing address
19 Old Selden Stage Rd
Selden, NY 11784-1501
Phone (631) 696-6985
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02556370 | Medicaid | NY |
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 |
|---|---|---|---|
| 263269-1 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1578642286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 OLD SELDEN STAGE RD",
"city": "SELDEN",
"state": "NY",
"postal_code": "117841501",
"telephone_number": "631-696-6985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 CONTINENTAL DR",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117764211",
"telephone_number": "631-828-6021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASILE",
"first_name": "LAURAJEAN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-03",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "263269-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02556370",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson Station, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.