Individual provider Active NPI

Grace Lisandrelli

  • Occupational Therapist
  • Great Neck, NY
National Provider Identifier
1013798560
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
027721 Issued in NY
Practice address
475 Northern Blvd Ste 19
Great Neck, NY 11021-4802
Phone
(516) 829-0030
NPI assigned
Oct 11, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 027721 NY Primary

Addresses

Primary practice location

475 Northern Blvd Ste 19
Great Neck, NY 11021-4802

Mailing address

2908 31St Ave Apt A4
Astoria, NY 11106-2805

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231024000895 NY Practitioner - Occupational Therapist in Private Practice 5395191647 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
New York University Medical College - NLG, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

880 Manhattan Ave
Suite 204
Brooklyn, NY 11222-7074
Phone (929) 590-2212

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
027721NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path Occupational Therapist CurrentSince Jan 15, 2024 Accepting new patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC CurrentSince Jan 15, 2024 Accepting new patients
Reddy Care Physical and Occupational Therapy PLLC CurrentSince Oct 9, 2023 Accepting new patients
Reddy Care Physical Therapy PC PastSince Oct 9, 2023 Accepting new patients

Locations

490 Driggs Ave
Brooklyn, NY 11211
Phone (347) 329-4572

309 Northwest Dr
Farmingdale, NY 11735
Phone (516) 420-2900

27278 Grand Central Pkwy
Floral Park, NY 11005
Phone (516) 344-0030

475 Northern Blvd
Ste 19
Great Neck, NY 11021
Phone (516) 344-0023

475 Northern Blvd
Ste 27
Great Neck, NY 11021

550 Mamaroneck Ave
Ste 104
Harrison, NY 10528
Phone (914) 777-3737

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1696982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1013798560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2908 31ST AVE APT A4",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111062805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 NORTHERN BLVD STE 19",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214802",
            "telephone_number": "516-829-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISANDRELLI",
        "first_name": "GRACE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-11",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "027721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.