Self

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

273750-1 Issued in NY

Legal business name

SELF

Practice address

1965 Lafayette Ave
Apt. 1G
Bronx, NY 10473-2502

Phone

(718) 824-0605

NPI assigned

May 23, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Gloria Z. Martin, LPN

Title

LPN

Phone

(347) 853-2849

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1274572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274572800000",
    "number": "1649599135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1965 LAFAYETTE AVE",
            "address_2": "APT. 1G",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104732502",
            "telephone_number": "718-824-0605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1965 LAFAYETTE AVE",
            "address_2": "APT. 1G",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104732502",
            "telephone_number": "718-824-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-23",
        "last_updated": "2010-05-23",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_middle_name": "Z.",
        "authorized_official_title_or_position": "LPN",
        "authorized_official_telephone_number": "347-853-2849",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NY",
            "license": "273750-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Bronx, NY
• Providers in Bronx, NY by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.