NPIMap

Organization Active NPI

Wyandanch PT, Family Health NP and Chiropractic PLLC

  • Physical Therapist
  • Wyandanch, NY
National Provider Identifier
1003454448
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
WYANDANCH PT, FAMILY HEALTH NP AND CHIROPRACTIC PLLC
Practice address
32 Station Drive
Wyandanch, NY 11798
Phone
(631) 242-4545
Fax
(631) 242-0885
NPI assigned
Dec 17, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Authorized official

Name
Dr. Jack Tesoriero, DCNPI 1871580282
Title
Owner
Phone
(631) 242-4500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

32 Station Drive
Wyandanch, NY 11798

Mailing address

2103 Deer Park Avenue
Deer Park, NY 11729
Phone (631) 242-4545

Other names 1

  • Wyandanch PTDC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1576540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576540800000",
    "number": "1003454448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 DEER PARK AVENUE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "11729",
            "telephone_number": "631-242-4545",
            "fax_number": "631-242-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 STATION DRIVE",
            "city": "WYANDANCH",
            "state": "NY",
            "postal_code": "11798",
            "telephone_number": "631-242-4545",
            "fax_number": "631-242-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYANDANCH PT, FAMILY HEALTH NP AND CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-17",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A",
        "authorized_official_last_name": "TESORIERO",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-242-4500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wyandanch PTDC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wyandanch, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; 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.