Leo Mirochnik, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

014055 Issued in NY

Practice address

1351 Forest Ave
Staten Island, NY 10302-2049

Phone

(917) 722-6883

NPI assigned

Dec 1, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1701388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1003682808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 ARDEN AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103121206",
            "telephone_number": "646-593-1417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103022049",
            "telephone_number": "917-722-6883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIROCHNIK",
        "first_name": "LEO",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-01",
        "last_updated": "2023-12-01",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "014055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janna Mirazita, LMSW
• Miriam Gordon Pediatric NP PC
• Miriam Rozenberg Et Al Lily Pond Nursing Home
• Brian F Mirman, DMD
• Boris Mirochnik
• Alena Mironova, LMSW
• Marina Mironova, NP
• Jan Misaylidi, PT, DPT
• Marissa Ashley Miscione
• Dina Mishiyeva, PA-C

• Physical Therapy Assistant in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; 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.