Upstate Ketamine Care

Primary specialty

Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X

Legal business name

UPSTATE KETAMINE CARE

Practice address

3300 Monroe Ave Ste 319
Rochester, NY 14618-4617

Phone

(585) 673-2319

NPI assigned

Nov 13, 2019

Last updated

Nov 13, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffrey C Leathersich

Title

Practice Administrator

Phone

(585) 673-2319

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573603200000",
    "number": "1710522875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 MONROE AVE STE 319",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146184617",
            "telephone_number": "585-673-2319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 MONROE AVE STE 319",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146184617",
            "telephone_number": "585-673-2319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE KETAMINE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-13",
        "last_updated": "2019-11-13",
        "status": "A",
        "authorized_official_last_name": "LEATHERSICH",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "585-673-2319"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03426666",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "patientcare@ketamine.care",
            "affiliation": "N",
            "endpointDescription": "Administrative Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PDF, DOC",
            "address_1": "3300 Monroe Ave Ste 319",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146184617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychiatric/Mental Health Clinical Nurse Specialist in Rochester, NY
• Providers in Rochester, NY by specialty
• Psychiatric/Mental Health Clinical Nurse Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; 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.