Active NPI
Irena Distasi, AU.D.
- Audiologist
- Brooklyn, NY
National Provider Identifier
1801066634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 002123
- Practice address
- 134 Atlantic Ave
Brooklyn, NY 11201-5502 - Phone
- (718) 780-2818
- NPI assigned
- Mar 7, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | 002123 | NY | Primary |
Addresses
Primary practice location
134 Atlantic Ave
Brooklyn, NY 11201-5502
Mailing address
450 Clarkson Ave
Brooklyn, NY 11203-2012
Phone (718) 270-1638
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02904974 | Medicaid | NY |
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)
- Enrolled
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404259200000",
"number": "1801066634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 CLARKSON AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112032012",
"telephone_number": "718-270-1638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "134 ATLANTIC AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112015502",
"telephone_number": "718-780-2818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISTASI",
"first_name": "IRENA",
"credential": "AU.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-07",
"last_updated": "2014-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "NY",
"license": "002123",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02904974",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.