NPIMap

Organization Active NPI

Sole Proprietor

  • Community/Behavioral Health Agency
  • Williston Park, NY
National Provider Identifier
1891187852
Registry record updated Feb 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
437022101 Issued in NY
Legal business name
SOLE PROPRIETOR
Practice address
610 Willis Ave Apt 1F
Williston Park, NY 11596-1221
Phone
(516) 770-2383
NPI assigned
Feb 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2015

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

Authorized official

Name
Mr. Brendan Michael Canavan, M.A.
Title
Abss
Phone
(516) 770-2383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 437022101 NY Primary

Addresses

Primary practice location

610 Willis Ave Apt 1F
Williston Park, NY 11596-1221

Mailing address

610 Willis Ave Apt 1F
Williston Park, NY 11596-1221
Phone (516) 770-2383

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1425081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425081600000",
    "number": "1891187852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 WILLIS AVE APT 1F",
            "city": "WILLISTON PARK",
            "state": "NY",
            "postal_code": "115961221",
            "telephone_number": "516-770-2383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 WILLIS AVE APT 1F",
            "city": "WILLISTON PARK",
            "state": "NY",
            "postal_code": "115961221",
            "telephone_number": "516-770-2383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLE PROPRIETOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-28",
        "last_updated": "2015-02-28",
        "status": "A",
        "authorized_official_last_name": "CANAVAN",
        "authorized_official_first_name": "BRENDAN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "ABSS",
        "authorized_official_telephone_number": "516-770-2383",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NY",
            "license": "437022101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williston Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2015; 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.