NPIMap

Organization Active NPI

Mary Josefyk DNP Aprn PA

Doing business as Main Avenue Medical

  • Primary Care Clinic/Center
  • Lake Placid, FL
National Provider Identifier
1942089453
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MARY JOSEFYK DNP APRN PA
Doing business as
Main Avenue Medical
Practice address
13 N Main Ave
Lake Placid, FL 33852-2603
Phone
(863) 659-1079
Fax
(863) 659-1317
NPI assigned
Sep 25, 2023
Last updated
Oct 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

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

Authorized official

Name
Mary E Josefyk, DNP APRNNPI 1831578145
Title
President
Phone
(863) 840-6095

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

13 N Main Ave
Lake Placid, FL 33852-2603

Mailing address

PO Box 718
Lake Placid, FL 33862-0718
Phone (863) 659-1079

Other names 1

  • Main Avenue Medical Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2318003Mary Josefyk, DNP, Aprn, PA13 N Main Ave, Lake Placid, FL 33852Certificate of waiverFeb 3, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1942089453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 718",
            "city": "LAKE PLACID",
            "state": "FL",
            "postal_code": "338620718",
            "telephone_number": "863-659-1079",
            "fax_number": "863-659-1317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 N MAIN AVE",
            "city": "LAKE PLACID",
            "state": "FL",
            "postal_code": "338522603",
            "telephone_number": "863-659-1079",
            "fax_number": "863-659-1317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY JOSEFYK DNP APRN PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "JOSEFYK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-840-6095",
        "authorized_official_credential": "DNP APRN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Avenue Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Placid, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.