Active NPI
Andre Michael Venner, MS, LAT, ATC
- Athletic Trainer
- Patchogue, NY
National Provider Identifier
1831741339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 002919-1
- Practice address
- 155 W Roe Blvd
Patchogue, NY 11772-2325 - Phone
- (914) 906-3735
- NPI assigned
- Jul 15, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 002919-1 | NY | Primary |
Addresses
Primary practice location
155 W Roe Blvd
Patchogue, NY 11772-2325
Mailing address
145 Dogwood Dr
Wading River, NY 11792-1605
Phone (914) 906-3735
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002919-1 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563148800000",
"number": "1831741339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 DOGWOOD DR",
"city": "WADING RIVER",
"state": "NY",
"postal_code": "117921605",
"telephone_number": "914-906-3735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 W ROE BLVD",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117722325",
"telephone_number": "914-906-3735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VENNER",
"first_name": "ANDRE",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "MS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-15",
"last_updated": "2019-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "002919-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Patchogue, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.