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JAZMIN RAYLENE GEM GORDON-ROSE
Complete NPI Record 1285287961
Social Worker in Brooklyn, NY

NPI Status: Active since July 22, 2019

Contact Information

1310 ROCKAWAY PKWY
BROOKLYN, NY
ZIP 11236
Phone: (718) 272-3300
Fax: (718) 927-1801

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider First Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Provider Gender Code
  22. Healthcare Provider Taxonomy Code 1
  23. Provider License Number 1
  24. Provider License Number State Code 1
  25. Healthcare Provider Primary Taxonomy Switch 1
  26. Is Sole Proprietor
  27. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1285287961. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1285287961
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider First Name: JAZMIN
The first name of the provider, if the provider is an individual.
Provider Middle Name: RAYLENE GEM
The first name of the provider, if the provider is an individual.
Provider First Line Business Mailing Address: 125 BROAD ST FL 3
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: NEW YORK
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NY
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 100042768
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 2123853030
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 1310 ROCKAWAY PKWY
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: BROOKLYN
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: NY
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 112362339
The city name in the location address of the provider being identified.
Provider Business Practice Location Address Country Code If outside U S : US
The State code in the location of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7182723300
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Fax Number: 7189271801
The country code in the location address of the provider being identified.
Provider Enumeration Date: 7/22/2019
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/22/2019
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Gender Code: F
The date that a record was last updated or changed.
Healthcare Provider Taxonomy Code 1: 104100000X
The code designating the provider’s gender if the provider is a person.
Provider License Number 1: 103191-1
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number State Code 1: NY
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Healthcare Provider Primary Taxonomy Switch 1: Y
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Is Sole Proprietor: Y
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP