Medardo Ocasiones Ebol Jr., RN

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

637484 Issued in NY

Practice address

Kirby Forensic Psychiatric Center
Wards Island Complex
Manhattan, NY 10035-6095

Phone

(914) 646-6800

Fax

(914) 646-6892

NPI assigned

Dec 23, 2019

Last updated

Dec 23, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1577059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1649819616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 WESTCHESTER AVE UNIT 110",
            "city": "PORT CHESTER",
            "state": "NY",
            "postal_code": "105733619",
            "telephone_number": "914-473-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "KIRBY FORENSIC PSYCHIATRIC CENTER",
            "address_2": "WARDS ISLAND COMPLEX",
            "city": "MANHATTAN",
            "state": "NY",
            "postal_code": "100356095",
            "telephone_number": "914-646-6800",
            "fax_number": "914-646-6892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBOL",
        "first_name": "MEDARDO",
        "middle_name": "OCASIONES",
        "name_suffix": "Jr.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-23",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "NY",
            "license": "637484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medardo.ebol@omh.ny.gov",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "Kirby Forensic Psychiatric Center",
            "address_2": "Wards island Complex",
            "city": "Manhattan",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100356095",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "medardo.ebol@omh.ny.gov",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "Kirby Forensic Psychiatric Center",
            "address_2": "Wards island Complex",
            "city": "Manhattan",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100356095",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Fionn Patrick Daly, MB, BCH, BAO
• Ritterdale Davis, CASAC-T
• Vanessa Depersiis, OTR/L
• Alan Ira Dolber
• Mary-Jackelyn Downing, LMHC
• Shamada Edwards, PMHNP
• Varsha Ganesh, LMSW
• Elizabeth Rose Grahn, NP-C
• Jodie M. Hanrahan, RPH
• Lauren Haythe, LAC, LMT

• Adult Psychiatric/Mental Health Registered Nurse in Manhattan, NY
• Providers in Manhattan, NY by specialty
• Adult Psychiatric/Mental Health Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; 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.