Active NPI
Gayle R Bardin-Daversa
- Occupational Therapist
- Sea Cliff, NY
National Provider Identifier
1770831794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 006787-1
- Practice address
- 10 Raymond CT
Sea Cliff, NY 11579-2028 - Phone
- (516) 676-0129
- Fax
- (516) 676-6435
- NPI assigned
- Aug 23, 2012
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 006787-1 | NY | Primary |
Addresses
Primary practice location
10 Raymond CT
Sea Cliff, NY 11579-2028
Mailing address
10 Raymond CT
Sea Cliff, NY 11579-2028
Phone (516) 676-0129
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 |
|---|---|---|---|
| 006787-1 | NY | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565913600000",
"number": "1770831794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 RAYMOND CT",
"city": "SEA CLIFF",
"state": "NY",
"postal_code": "115792028",
"telephone_number": "516-676-0129",
"fax_number": "516-676-6435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 RAYMOND CT",
"city": "SEA CLIFF",
"state": "NY",
"postal_code": "115792028",
"telephone_number": "516-676-0129",
"fax_number": "516-676-6435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARDIN-DAVERSA",
"first_name": "GAYLE",
"middle_name": "R",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-23",
"last_updated": "2019-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "006787-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sea Cliff, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.