Active NPI
Fleurette M Fanfan, OTR
- Occupational Therapist
- Valley Stream, NY
National Provider Identifier
1962773200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 012861
- Practice address
- 11 Park PL
Valley Stream, NY 11580-3000 - Phone
- (212) 464-7958
- NPI assigned
- Jan 18, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 012861 | NY | Primary |
Addresses
Primary practice location
11 Park PL
Valley Stream, NY 11580-3000
Mailing address
11 Park PL
Valley Stream, NY 11580-3000
Phone (212) 464-7958
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012861 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326844800000",
"number": "1962773200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 PARK PL",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115803000",
"telephone_number": "212-464-7958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 PARK PL",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115803000",
"telephone_number": "212-464-7958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANFAN",
"first_name": "FLEURETTE",
"middle_name": "M",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-01-18",
"last_updated": "2012-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "012861",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Stream, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.