Active NPI
Norman Mickenberg, M.D.
- Legal Medicine
- Jamaica, NY
National Provider Identifier
1740580406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Legal Medicine
- License
- 90036
- Practice address
- 18162 Tudor Rd
Jamaica, NY 11432-1447 - Phone
- (718) 380-0939
- NPI assigned
- Oct 28, 2010
- 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 |
|---|---|---|---|---|
| Legal Medicine | 173000000X | 90036 | NY | Primary |
Addresses
Primary practice location
18162 Tudor Rd
Jamaica, NY 11432-1447
Mailing address
18162 Tudor Rd
Jamaica, NY 11432-1447
Phone (718) 380-0939
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 90036 | NY | MD | Legal Medicine |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288224000000",
"number": "1740580406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18162 TUDOR RD",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114321447",
"telephone_number": "718-380-0939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18162 TUDOR RD",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114321447",
"telephone_number": "718-380-0939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKENBERG",
"first_name": "NORMAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-28",
"last_updated": "2010-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "173000000X",
"taxonomy_group": "",
"desc": "Legal Medicine",
"state": "NY",
"license": "90036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.