Individual provider Active NPI

Antonietta De Los Reyes, FNP

  • Nurse Practitioner
  • Staten Island, NY
National Provider Identifier
1639277288
Registry record updated Jun 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
F334883 Issued in NY
Practice address
1361 Hylan Blvd
Staten Island, NY 10305-1902
Phone
(718) 979-2828
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X F334883 NY Primary
Family Nurse Practitioner 363LF0000X 26NJ00169800 NJ

Addresses

Primary practice location

1361 Hylan Blvd
Staten Island, NY 10305-1902

Mailing address

10752 93Rd St
Ozone Park, NY 11417-1507
Phone (646) 220-9055

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
I20090608000086 NY Practitioner - Nurse Practitioner 1254496847 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, shared by 32 NPIs, 2,809 clinicians

Practice addresses (Care Compare)

10 E 102ND St
Tisch Dept of Mount Sinai
New York, NY 10029-6030
Phone (212) 844-8288

Hospital & facility affiliations

  • Mount Sinai Hospital Hospital, New York, NY, CCN 330024

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
33483NYMDPharmacist
334883NYMDPsychiatry Physician
F334883NYMDNurse Practitioner
26NJ00169800NJMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Jun 16, 2020 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jun 16, 2020 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Oct 1, 2021 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

5 E 98th St
#1
New York, NY 10029
Phone (212) 241-8004

1450 Madison Ave
New York, NY 10029
Phone (212) 241-1912

10 E 102nd St
New York, NY 10029
Phone (212) 241-5656

5 E 98th St
Fl 12
New York, NY 10029
Phone (212) 241-8303

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244160000000",
    "number": "1639277288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10752 93RD ST",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114171507",
            "telephone_number": "646-220-9055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103051902",
            "telephone_number": "718-979-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LOS REYES",
        "first_name": "ANTONIETTA",
        "name_prefix": "Miss",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "F334883",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00169800",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.