Active NPI
Edward J Modica, ATC,EMT-B
- Specialist
- Massapequa, NY
National Provider Identifier
1821312331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 000370-1
- Practice address
- 434 N Bleecker Dr
Massapequa, NY 11758-1340 - Phone
- (516) 721-6541
- NPI assigned
- Mar 26, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 000370-1 | NY | Primary |
Addresses
Primary practice location
434 N Bleecker Dr
Massapequa, NY 11758-1340
Mailing address
434 N Bleecker Dr
Massapequa, NY 11758-1340
Phone (516) 721-6541
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000370-1 | Other | NY | NY STATE 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000370-1 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269561600000",
"number": "1821312331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "434 N BLEECKER DR",
"city": "MASSAPEQUA",
"state": "NY",
"postal_code": "117581340",
"telephone_number": "516-721-6541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "434 N BLEECKER DR",
"city": "MASSAPEQUA",
"state": "NY",
"postal_code": "117581340",
"telephone_number": "516-721-6541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODICA",
"first_name": "EDWARD",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "ATC,EMT-B",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-26",
"last_updated": "2010-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "000370-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY STATE LICENSE",
"identifier": "000370-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Massapequa, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.