Alliyah Okhamvilaysack | NPI 1912422304

Key facts

NPI: 1912422304
Entity type: Individual (NPI type 1)
Primary specialty: Basic Emergency Medical Technician 146N00000X
Practice address: 3255 Route 39
Bliss, NY 14024-9730
Phone: (716) 258-1235
NPI assigned: Aug 7, 2017
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Basic Emergency Medical Technician	146N00000X			Yes

Addresses

Primary practice location

3255 Route 39
Bliss, NY 14024-9730

Mailing address

3255 Route 39
Bliss, NY 14024-9730

Other identifiers

Identifier	Type	State	Issuer
431787	Other		EMT-B

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 7, 2017.

{
    "created_epoch": "1502064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502064000000",
    "number": "1912422304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3255 ROUTE 39",
            "city": "BLISS",
            "state": "NY",
            "postal_code": "140249730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 ROUTE 39",
            "city": "BLISS",
            "state": "NY",
            "postal_code": "140249730",
            "telephone_number": "716-258-1235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKHAMVILAYSACK",
        "first_name": "ALLIYAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-07",
        "last_updated": "2017-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMT-B",
            "identifier": "431787",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bliss, NY

All providers in Bliss, NY · Basic Emergency Medical Technician in New York

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2017. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.