Proactive Adult Health NP, P.C.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

PROACTIVE ADULT HEALTH NP, P.C.

Practice address

17 Linmouth Rd
Malverne, NY 11565-2202

Phone

(516) 915-9771

NPI assigned

Nov 11, 2022

Last updated

Nov 11, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Peter Duperval, NURSE PRACTITIONER

Title

Owner

Phone

(516) 915-9771

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1668124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668124800000",
    "number": "1932817533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 292",
            "city": "MALVERNE",
            "state": "NY",
            "postal_code": "115650292",
            "telephone_number": "516-915-9771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 LINMOUTH RD",
            "city": "MALVERNE",
            "state": "NY",
            "postal_code": "115652202",
            "telephone_number": "516-915-9771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE ADULT HEALTH NP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-11",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A",
        "authorized_official_last_name": "DUPERVAL",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-915-9771",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Ryan-Johnson, LCSW PLLC
• Erica Ashley Pearsall, OTR
• Dilmarys Pena, D.D.S.
• Adrienne Perlaza, M.A. CCC/SLP
• Dawn Victoria Powell
• R & V NP in Psychiatric Services PLLC
• Amitha Raghubir, PT
• Samantha Ramos
• Karen Rienzi, OTR/L
• Kathryn Risolo, OTRL

• Medical Specialty Clinic/Center in Malverne, NY
• Providers in Malverne, NY by specialty
• Medical Specialty Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2022; 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.