NPIMap

Organization Active NPI

Northlake Rehab Professionals

  • Specialist
  • Hammond, LA
National Provider Identifier
1699744664
Registry record updated Apr 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
09912R Issued in LA
Legal business name
NORTHLAKE REHAB PROFESSIONALS
Practice address
2101 Robin Ave
Hammond, LA 70403-5772
Phone
(985) 345-0033
Fax
(985) 345-1199
NPI assigned
Mar 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

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

Authorized official

Name
Dr. Randolph L Roig, M.D.NPI 1487757043
Title
Owner
Phone
(985) 345-0033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X 09912R LA Primary
Gerontology Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LG0600X AP04607 AL

Addresses

Primary practice location

2101 Robin Ave
Hammond, LA 70403-5772

Mailing address

2101 Robin Ave
Hammond, LA 70403-5773
Phone (985) 345-0033

Other identifiers 2

IdentifierTypeStateIssuer
1680818MedicaidLA
1625345MedicaidLA

National Provider Directory

National Provider Directory

Locations

2101 Robin Ave
Ste 3
Hammond, LA 70403
Phone (504) 345-0033

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1699744664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 ROBIN AVE",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704035773",
            "telephone_number": "985-345-0033",
            "fax_number": "985-345-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 ROBIN AVE",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704035772",
            "telephone_number": "985-345-0033",
            "fax_number": "985-345-1199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE REHAB PROFESSIONALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "ROIG",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-345-0033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "LA",
            "license": "09912R",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AL",
            "license": "AP04607",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1680818",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1625345",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hammond, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; 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.