Active NPI
Chandia Ellen Jackson-Hodges, RPA-C
- Physician Assistant
- New Hyde Park, NY
National Provider Identifier
1962671446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 011057
- Practice address
- 410 Lakeville Rd
Suite 206a
New Hyde Park, NY 11042-1101 - Phone
- (718) 470-7644
- NPI assigned
- Feb 28, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 011057 | NY | Primary |
Addresses
Primary practice location
410 Lakeville Rd
Suite 206a
New Hyde Park, NY 11042-1101
Mailing address
410 Lakeville Rd
Suite 206a
New Hyde Park, NY 11042-1101
Phone (718) 470-7644
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011057 | NY | MD | Clinical Psychologist |
Interoperability endpoints
- cjacksonhodges20540@northwell.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204156800000",
"number": "1962671446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 LAKEVILLE RD",
"address_2": "SUITE 206A",
"city": "NEW HYDE PARK",
"state": "NY",
"postal_code": "110421101",
"telephone_number": "718-470-7644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 LAKEVILLE RD",
"address_2": "SUITE 206A",
"city": "NEW HYDE PARK",
"state": "NY",
"postal_code": "110421101",
"telephone_number": "718-470-7644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON-HODGES",
"first_name": "CHANDIA",
"middle_name": "ELLEN",
"name_prefix": "Mrs.",
"credential": "RPA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-28",
"last_updated": "2008-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "011057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Hyde Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.