Active NPI
Kelly Song
- Occupational Therapist
- Little Neck, NY
National Provider Identifier
1780153932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 023019
- Practice address
- 4515 Browvale LN
Little Neck, NY 11362-1305 - Phone
- (516) 603-6146
- NPI assigned
- Nov 16, 2018
- 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 | 023019 | NY | Primary |
Addresses
Primary practice location
4515 Browvale LN
Little Neck, NY 11362-1305
Mailing address
4515 Browvale LN
Little Neck, NY 11362-1305
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 023019 | Other | NY | NYS LICENSE # |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542326400000",
"number": "1780153932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4515 BROWVALE LN",
"city": "LITTLE NECK",
"state": "NY",
"postal_code": "113621305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4515 BROWVALE LN",
"city": "LITTLE NECK",
"state": "NY",
"postal_code": "113621305",
"telephone_number": "516-603-6146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-11-16",
"last_updated": "2018-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": "NY",
"license": "023019",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NYS LICENSE #",
"identifier": "023019",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Little Neck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.