Bryan Lackey, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

403117 Issued in NY

Practice address

230 Park Ave FL 3
New York, NY 10169-0018

Phone

(516) 505-7200

Fax

(949) 419-3482

NPI assigned

Aug 6, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, NJ2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Aldad Medical NJ PCGroup PAC ID 4981011988, 10 clinicians

Aldad Medical PCGroup PAC ID 9234291436, 78 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aldad Medical NJ, P.C

  • Psychiatry Physician
  • Hoboken, NJ
  • NPI 1386238707
  Medicare reassignment Care Compare group NPD
• Aldad Medical PC

  • Psychiatry Physician
  • Ann Arbor, MI
  • NPI 1174784953

  NY

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1596672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660435200000",
    "number": "1891305645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 PARK AVE FL 3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101690018",
            "telephone_number": "347-861-6651",
            "fax_number": "949-419-3482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 PARK AVE FL 3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101690018",
            "telephone_number": "516-505-7200",
            "fax_number": "949-419-3482"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "221 River St",
            "address_2": "9th Floor",
            "address_purpose": "LOCATION",
            "city": "Hoboken",
            "state": "NJ",
            "postal_code": "07030",
            "country_code": "US",
            "telephone_number": "201-308-8252",
            "fax_number": "949-419-3482",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "BRYAN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-06",
        "last_updated": "2022-08-14",
        "certification_date": "2022-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ01045800",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Lachs, MD
• Sadie Lacina, OTR/L
• Susan Lacina, CNP
• Carolyn Rebecca Lack, DPT
• Judyta Otylia Lacka, MS
• Roy S Lackey, MD
• Michael Joesph Lackner, P.A.
• Jacob Lackow, M.A.
• Juliette Rose Lackow, LMSW
• Rachel Stephanie Lacks, ED.M.

• Psychiatric/Mental Health Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2022; 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.

Verify at the official NPI Registry.