Active NPI
Jennifer Daly
- Community Health Worker
- Staten Island, NY
National Provider Identifier
1700169778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 011148
- Practice address
- 120 Rathbun Ave
Staten Island, NY 10312-3006 - Phone
- (718) 948-8879
- NPI assigned
- Sep 26, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 011148 | NY | Primary |
Addresses
Primary practice location
120 Rathbun Ave
Staten Island, NY 10312-3006
Mailing address
7 Ientile Court
Monroe, NJ 08831
Phone (646) 239-0594
Other names 1
- Jennifer Daly
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 |
|---|---|---|---|
| 011148 | NY | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MLR Speech Language Pathology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Speech-Language Pathologist
- Staten Island, NY
- NPI 1669787529
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316995200000",
"number": "1700169778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 IENTILE COURT",
"city": "MONROE",
"state": "NJ",
"postal_code": "08831",
"telephone_number": "646-239-0594"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 RATHBUN AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103123006",
"telephone_number": "718-948-8879"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALY",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-26",
"last_updated": "2011-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NY",
"license": "011148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "DALY",
"credential": "OT",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.