Individual provider Active NPI

Pamela Bubb

  • Prevention Professional
  • Brooklyn, NY
National Provider Identifier
1972011039
Registry record updated Jan 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prevention ProfessionalTaxonomy code 405300000X
License
0852822 Issued in NY
Practice address
357 17TH St
Brooklyn, NY 11215-6113
Phone
(917) 617-4084
NPI assigned
Jan 11, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prevention ProfessionalGroup: 193400000X SINGLE SPECIALTY GROUP 405300000X 0852822 NY Primary

Addresses

Primary practice location

357 17TH St
Brooklyn, NY 11215-6113

Mailing address

359 17TH St
Brooklyn, NY 11215-6113

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

LicenseStateTypeSpecialty
0852822NYMDPrevention Professional

NPI Registry JSON

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

{
    "created_epoch": "1515628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515628800000",
    "number": "1972011039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "359 17TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112156113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 17TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112156113",
            "telephone_number": "917-617-4084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUBB",
        "first_name": "PAMELA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-11",
        "last_updated": "2018-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Prevention Professional",
            "state": "NY",
            "license": "0852822",
            "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 Jan 11, 2018; 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.