Sean Engebretsen

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

288008 Issued in NY

Practice address

15 Private Rd
Medford, NY 11763-3723

Phone

(631) 327-2492

NPI assigned

Sep 20, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316476800000",
    "number": "1790068328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PRIVATE RD",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117633723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PRIVATE RD",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117633723",
            "telephone_number": "631-327-2492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGEBRETSEN",
        "first_name": "SEAN",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-20",
        "last_updated": "2011-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "288008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Mark Ellis, D.D.S., M.S.,C.N.S
• Regina Marie Ely, LCSW
• Edwin A Emerson, D.C.
• Emily Chappell, LCSW-R, P.C.
• Empire Vision Center Inc
• Keri Ann Engel, LPN
• Joselyn Escajadillo
• Maureen Teresa Escobar, M.A., CCC/SLP
• Kristen Beth Esposito, NP
• Evolving Gait Physical Therapy

• Licensed Practical Nurse in Medford, NY
• Providers in Medford, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.

Verify at the official NPI Registry.