Active NPI
Alfred Clayton Bannerman, M.D.
- Neurology Physician
- Jamaica, NY
National Provider Identifier
1649231366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 111142
- Practice address
- 8900 Van Wyck Expressway
Jamaica, NY 11418-2832 - Phone
- (718) 206-7089
- Fax
- (718) 206-7055
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 111142 | NY | Primary |
Addresses
Primary practice location
8900 Van Wyck Expressway
Jamaica, NY 11418-2832
Mailing address
180 Salem Road
Westbury, NY 11590
Phone (516) 997-3269
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14071762 | Medicaid | CO | |
| 42551056 | Medicaid | NM | |
| 084255 | Medicaid | AZ |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416873600000",
"number": "1649231366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 SALEM ROAD",
"city": "WESTBURY",
"state": "NY",
"postal_code": "11590",
"telephone_number": "516-997-3269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8900 VAN WYCK EXPRESSWAY",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114182832",
"telephone_number": "718-206-7089",
"fax_number": "718-206-7055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANNERMAN",
"first_name": "ALFRED",
"middle_name": "CLAYTON",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2014-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NY",
"license": "111142",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "14071762",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42551056",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "084255",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.