Individual provider Active NPI

Bobby Gray, LPN

  • Licensed Practical Nurse
  • Depew, NY
National Provider Identifier
1649779612
Registry record updated Feb 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
327456 Issued in NY
Practice address
474 Dick Rd, Apt A3
Depew, NY 14043-1404
Phone
(716) 573-1224
Fax
(716) 573-1224
NPI assigned
Feb 6, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 327456 NY Primary

Addresses

Primary practice location

474 Dick Rd, Apt A3
Depew, NY 14043-1404

Mailing address

474 Dick Rd Apt A3
Depew, NY 14043-1840
Phone (716) 573-1224

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

LicenseStateTypeSpecialty
327456NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1517875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517875200000",
    "number": "1649779612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 DICK RD APT A3",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140431840",
            "telephone_number": "716-573-1224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 DICK RD, APT A3",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140431404",
            "telephone_number": "716-573-1224",
            "fax_number": "716-573-1224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "BOBBY",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-06",
        "last_updated": "2018-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "327456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Depew, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2018; 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.