Individual provider Active NPI

Debra Ann Farenga, NP

  • Adult Health Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1962430959
Registry record updated Jun 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F301386 Issued in NY
Practice address
1000 E Genesee St
Ste 205 & 205
Syracuse, NY 13210-1892
Phone
(315) 464-1600
Fax
(315) 464-1601
NPI assigned
Jun 29, 2006
Last updated
Jun 18, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F301386 NY Primary
Family Nurse Practitioner 363LF0000X F333162 NY

Addresses

Primary practice location

1000 E Genesee St
Ste 205 & 205
Syracuse, NY 13210-1892

Mailing address

1000 E Genesee St
Ste 205 & 205
Syracuse, NY 13210-1892
Phone (315) 464-1600

Other identifiers 1

IdentifierTypeStateIssuer
01857318MedicaidNY

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F301386NYMDAdult Health Nurse Practitioner
F333162NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Network of Central New York, Inc. Past Accepting new patients
Otter Creek Medical Office, LLP PastSince Oct 1, 1997 Accepting new patients
Goldwyn & Boyland Physical Therapy PC PastSince Nov 2, 2018 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: dfarenga@hiemail.healtheconnections.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403049600000",
    "number": "1962430959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E GENESEE ST",
            "address_2": "STE 205 & 205",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101892",
            "telephone_number": "315-464-1600",
            "fax_number": "315-464-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E GENESEE ST",
            "address_2": "STE 205 & 205",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101892",
            "telephone_number": "315-464-1600",
            "fax_number": "315-464-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARENGA",
        "first_name": "DEBRA",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2014-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F301386",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F333162",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01857318",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; 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.