Active NPI
Anthony J Detore, RN
- Home Health Registered Nurse
- Bohemia, NY
National Provider Identifier
1669077426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Registered Nurse
- License
- 723193-01
- Practice address
- 17 Bourne Blvd
Bohemia, NY 11716-4901 - Phone
- (631) 987-2061
- NPI assigned
- Dec 1, 2020
- 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 |
|---|---|---|---|---|
| Home Health Registered Nurse | 163WH0200X | 723193-01 | NY | Primary |
Addresses
Primary practice location
17 Bourne Blvd
Bohemia, NY 11716-4901
Mailing address
17 Bourne Blvd
Bohemia, NY 11716-4901
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 723193-01 | NY | MD | Home Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606780800000",
"number": "1669077426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 BOURNE BLVD",
"city": "BOHEMIA",
"state": "NY",
"postal_code": "117164901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 BOURNE BLVD",
"city": "BOHEMIA",
"state": "NY",
"postal_code": "117164901",
"telephone_number": "631-987-2061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETORE",
"first_name": "ANTHONY",
"middle_name": "J",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-01",
"last_updated": "2020-12-01",
"certification_date": "2020-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "163WH0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Home Health",
"state": "NY",
"license": "723193-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bohemia, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.