Miriam Lee Pennise, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

379-297 RN Issued in NY

Practice address

340 Veterans Hwy Ste 12
Commack, NY 11725-4300

Phone

(631) 486-8400

Fax

(631) 486-8080

NPI assigned

Sep 19, 2006

Last updated

Dec 6, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Miriam Lee Duran Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mark Gasparini, D.P.M. P.C.

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  NPD

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

{
    "created_epoch": "1158624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1790882397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 VETERANS HWY STE 12",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117254300",
            "telephone_number": "631-486-8400",
            "fax_number": "631-486-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 VETERANS HWY STE 12",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117254300",
            "telephone_number": "631-486-8400",
            "fax_number": "631-486-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNISE",
        "first_name": "MIRIAM",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-19",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "301536 NP",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "379-297 RN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRIAM",
            "last_name": "DURAN",
            "middle_name": "LEE",
            "prefix": "MRS.",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pediatric Physical Therapy Associates of Western Suffolk, P.C.
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• Digna Maricela Pena-Hollwedel, MS
• Alexandra Marte Penalver
• Jennifer Perciavalle, LCSW, CASAC-G
• Eleanor Frankel Perlman, LCSW, DCSW, BCD
• Ann Marie Perrino, NP
• Debra Michele Perron, PTA
• Lisa Perryfink

• Adult Health Nurse Practitioner in Commack, NY
• Providers in Commack, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; 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.