Individual provider Active NPI

Dean J Etri, D.C.

  • Chiropractor
  • Brooklyn, NY
National Provider Identifier
1942419833
Registry record updated May 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X005951 Issued in NY
Practice address
2116 Avenue P
Brooklyn, NY 11229-1507
Phone
(347) 751-5199
Fax
(718) 338-7117
NPI assigned
May 21, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X X005951 NY Primary

Addresses

Primary practice location

2116 Avenue P
Brooklyn, NY 11229-1507

Mailing address

61 Bruno LN
Staten Island, NY 10307-2227
Phone (347) 751-5199

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110426000337 NY Practitioner - Chiropractic 0345311064 Reassigns benefits to 1 organization
Practice locations: Staten Island, NY; Brooklyn, NY

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

318 Seguine Ave
Staten Island, NY 10309-3941
Phone (718) 356-9222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
X005951NYMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Adjustment Chiropractic PC Chiropractor CurrentSince Dec 1, 2023 Accepting new patients
Mermaid Management Inc PastSince Jun 1, 2011 Accepting new patients
Jal 28 LLC Past Accepting new patients

Locations

318 Seguine Ave
Staten Island, NY 10309
Phone (718) 356-9222

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": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588809600000",
    "number": "1942419833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 BRUNO LN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103072227",
            "telephone_number": "347-751-5199",
            "fax_number": "718-338-7117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2116 AVENUE P",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291507",
            "telephone_number": "347-751-5199",
            "fax_number": "718-338-7117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETRI",
        "first_name": "DEAN",
        "middle_name": "J",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X005951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.