Statewide Telehealth

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

STATEWIDE TELEHEALTH

Practice address

89 Junard Dr
Bay Shore, NY 11706-4516

Phone

(254) 244-1660

NPI assigned

Feb 9, 2021

Organization subpart

No

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

Authorized official

Name

Carmen DiazNPI 1114519378

Title

Office Managr

Phone

(254) 244-1660

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carmen Diaz

  • Family Medicine Physician
  • Bay Shore, NY
  • NPI 1114519378
  NPD Authorized official

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

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612828800000",
    "number": "1659963718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 JUNARD DR",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117064516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 JUNARD DR",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117064516",
            "telephone_number": "254-244-1660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEWIDE TELEHEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_title_or_position": "OFFICE MANAGR",
        "authorized_official_telephone_number": "254-244-1660"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "829824969",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "NewYork",
            "affiliation": "N",
            "address_1": "89 Junard Dr",
            "city": "Bay Shore",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117064516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Siobhan Catherine Stack, DPT
• Theresa Maria Stallone, REGISTERED NURSE
• Colleen Stanley, LMFT
• Kayla Marie Stanton
• Star PT
• James Derek Steele, PA
• Robert Lewis Stein, D.M.D.
• Constance L Steinberg, LMSW CLINICAL SW
• Lauren Steinert, PA-C
• Pamela Marie Stengel, NP

• Pharmacy in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; 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.