Samuel R Mickens, RN

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

569459-1 Issued in NY

Practice address

175 Remsen St FL 10
Brooklyn, NY 11201-4300

Phone

(718) 852-5552

NPI assigned

Jan 27, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

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.

• Bridge Back to Life Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Brooklyn, NY
  • NPI 1881922508
  NPD (past)
• Bridge Back to Life Center, Inc.

  • Multi-Specialty Clinic/Center
  • Bethpage, NY
  • NPI 1518918101

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1264550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264550400000",
    "number": "1942531132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 REMSEN ST FL 10",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112014300",
            "telephone_number": "718-852-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 REMSEN ST FL 10",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112014300",
            "telephone_number": "718-852-5552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKENS",
        "first_name": "SAMUEL",
        "middle_name": "R",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-27",
        "last_updated": "2010-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "569459-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN",
            "identifier": "569459-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Attis Corporation
• Michelle Carissimi LLC
• Michelle Gofman
• Shira Michelson, LMSW
• Yitzchok Michelson
• George Mickles III
• Sheri Micklin
• Mid Manhattan Medical, P.C.
• Midas Diagnostic Solutions Inc
• Kendra Midcap

• Addiction (Substance Use Disorder) Registered Nurse in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Addiction (Substance Use Disorder) Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2010; 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.