Individual provider Active NPI

Robert Lee Terrelonge, NPP, ANP

  • Psychiatric/Mental Health Nurse Practitioner
  • Valley Stream, NY
National Provider Identifier
1902056005
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F400836 Issued in NY
Practice address
33 Clarendon Dr
Valley Stream, NY 11580-2503
Phone
(516) 376-4111
Fax
(516) 593-1307
NPI assigned
Sep 25, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F400836 NY Primary

Addresses

Primary practice location

33 Clarendon Dr
Valley Stream, NY 11580-2503

Mailing address

33 Clarendon Dr
Valley Stream, NY 11580-2503
Phone (516) 376-4111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20180912000233 NY Practitioner - Nurse Practitioner 3173686201 Reassigns benefits to 1 organization
Practice locations: Far Rockaway, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F400836NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vocational Instruction Project Community Services, Inc. CurrentSince Jun 23, 2018 Accepting new patients
Vocational Instruction Project Community Services Inc CurrentSince Jun 23, 2018 Accepting new patients
Vocational Instruction Project Community Services Inc Past Accepting new patients

Locations

770 E 176th St
Fl 2
Bronx, NY 10460
Phone (718) 583-5150

770 E 176th St
Fl 3
Bronx, NY 10460
Phone (718) 583-5150

770 E 176th St
Bronx, NY 10460
Phone (718) 466-8034

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1902056005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 CLARENDON DR",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115802503",
            "telephone_number": "516-376-4111",
            "fax_number": "516-593-1307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 CLARENDON DR",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115802503",
            "telephone_number": "516-376-4111",
            "fax_number": "516-593-1307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERRELONGE",
        "first_name": "ROBERT",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "NPP,     ANP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-25",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F400836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

Verify at the official NPI Registry.