Active NPI
Alyssa Gardner
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Kenmore, NY
National Provider Identifier
1013642081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 2081S0010X
- Practice address
- 40 Goodyear Road
Kenmore, NY 14217-1421 - Phone
- (716) 803-0115
- NPI assigned
- Jul 22, 2022
- 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 |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 2081S0010X | NY | Primary |
Addresses
Primary practice location
40 Goodyear Road
Kenmore, NY 14217-1421
Mailing address
2933 Delaware Ave Apt 4
Kenmore, NY 14217-2336
Phone (716) 803-0115
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 |
|---|---|---|---|
| 2081S0010X | NY | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658448000000",
"number": "1013642081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2933 DELAWARE AVE APT 4",
"city": "KENMORE",
"state": "NY",
"postal_code": "142172336",
"telephone_number": "716-803-0115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 GOODYEAR ROAD",
"city": "KENMORE",
"state": "NY",
"postal_code": "142171421",
"telephone_number": "716-803-0115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "ALYSSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-22",
"last_updated": "2022-07-22",
"certification_date": "2022-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "NY",
"license": "2081S0010X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenmore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.