Active NPI
Maryellen Klaiber, N.P.
- Adult Health Nurse Practitioner
- Amityville, NY
National Provider Identifier
1821206202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- F301203
- Practice address
- 400 Sunrise Hwy
Amityville, NY 11701-2508 - Phone
- (631) 264-4000
- Fax
- (631) 396-0025
- NPI assigned
- May 18, 2007
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | F301203 | NY | Primary |
Addresses
Primary practice location
400 Sunrise Hwy
Amityville, NY 11701-2508
Mailing address
400 Sunrise Hwy
Amityville, NY 11701-2508
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| F301203 | Other | NY | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- State University of New York at Stony Brook, School of Medicine, 1994
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
400 Sunrise Hwy
Amityville, NY 11701-2508
Phone (631) 608-5149
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F301203 | NY | MD | Adult Health Nurse Practitioner |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201392000000",
"number": "1821206202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 SUNRISE HWY",
"city": "AMITYVILLE",
"state": "NY",
"postal_code": "117012508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 SUNRISE HWY",
"city": "AMITYVILLE",
"state": "NY",
"postal_code": "117012508",
"telephone_number": "631-264-4000",
"fax_number": "631-396-0025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLAIBER",
"first_name": "MARYELLEN",
"credential": "N.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2008-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "NY",
"license": "F301203",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "F301203",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amityville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.