John M Fredericks Jr., LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

217537-1 Issued in NY

Practice address

2975 Rte 9
Cold Spring
New York, NY 10516

Phone

(646) 925-4469

NPI assigned

Nov 17, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. John M Fredericks Jr. Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1479340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479686400000",
    "number": "1871035162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 RTE 9",
            "city": "COLD SPRING",
            "state": "NY",
            "postal_code": "10516",
            "telephone_number": "646-925-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 RTE 9",
            "address_2": "COLD SPRING",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10516",
            "telephone_number": "646-925-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-17",
        "last_updated": "2016-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "217537-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "FREDERICKS",
            "middle_name": "M",
            "prefix": "MR.",
            "suffix": "JR.",
            "credential": "LPN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jeremy J Frederick, MD
• Mary Margaret Frederick, PH.D.
• Nicole Marie Frederick, L.AC
• Shauna Louise Cynthia Frederick, LMSW
• Tamara Frederick, CASAC
• Nadia N Fredericks, RD
• Samuel Fredericks
• Denise Rae Fredette, L.C.S.W
• Douglas Fredman, DC
• Rena Fredman, PSY.D.

• Licensed Practical Nurse in New York, NY
• Providers in New York, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; 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.