Active NPI
William Jantzen, PT
- Physical Therapist
- Wading River, NY
National Provider Identifier
1023098217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 009864-1
- Practice address
- 5958 Route 25a
Wading River, NY 11792-2001 - Phone
- (631) 929-8200
- Fax
- (631) 929-8228
- NPI assigned
- Jan 23, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 009864-1 | NY | Primary |
Addresses
Primary practice location
5958 Route 25a
Wading River, NY 11792-2001
Mailing address
5958 Route 25a
Wading River, NY 11792-2001
Phone (631) 929-8200
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009864 | NY | MD | Occupational Therapy Assistant |
| 009864-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494460800000",
"number": "1023098217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5958 ROUTE 25A",
"city": "WADING RIVER",
"state": "NY",
"postal_code": "117922001",
"telephone_number": "631-929-8200",
"fax_number": "631-929-8228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5958 ROUTE 25A",
"city": "WADING RIVER",
"state": "NY",
"postal_code": "117922001",
"telephone_number": "631-929-8200",
"fax_number": "631-929-8228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANTZEN",
"first_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-23",
"last_updated": "2017-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "009864-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wading River, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.