Active NPI
Ericka J Ennis
- Peer Specialist
- Brooklyn, NY
National Provider Identifier
1679311641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 5180
- Practice address
- 1623 Flatbush Ave
Brooklyn, NY 11210-3262 - Phone
- (718) 377-5755
- NPI assigned
- Jul 16, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 5180 | NY | Primary |
Addresses
Primary practice location
1623 Flatbush Ave
Brooklyn, NY 11210-3262
Mailing address
1623 Flatbush Ave # 1623
Brooklyn, NY 11210-3262
Phone (646) 755-1345
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
| License | State | Type | Specialty |
|---|---|---|---|
| 5180 | NY | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721088000000",
"number": "1679311641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1623 FLATBUSH AVE # 1623",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112103262",
"telephone_number": "646-755-1345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1623 FLATBUSH AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112103262",
"telephone_number": "718-377-5755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNIS",
"first_name": "ERICKA",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-16",
"last_updated": "2024-07-16",
"certification_date": "2024-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NY",
"license": "5180",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.