Active NPI
John Christopher Micena, MSPT
- Physical Therapist
- Massapequa, NY
National Provider Identifier
1023113776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 019608-1
- Practice address
- 200 Boundary Ave
Suite 205
Massapequa, NY 11758 - Phone
- (516) 586-4766
- Fax
- (516) 586-4758
- NPI assigned
- Sep 14, 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 | 019608-1 | NY | Primary |
Addresses
Primary practice location
200 Boundary Ave
Suite 205
Massapequa, NY 11758
Mailing address
200 Boundary Ave
Suite 205
Massapequa, NY 11758
Phone (516) 586-4766
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 |
|---|---|---|---|
| 019608-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202947200000",
"number": "1023113776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 BOUNDARY AVE",
"address_2": "SUITE 205",
"city": "MASSAPEQUA",
"state": "NY",
"postal_code": "11758",
"telephone_number": "516-586-4766",
"fax_number": "516-586-4758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 BOUNDARY AVE",
"address_2": "SUITE 205",
"city": "MASSAPEQUA",
"state": "NY",
"postal_code": "11758",
"telephone_number": "516-586-4766",
"fax_number": "516-586-4758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICENA",
"first_name": "JOHN",
"middle_name": "CHRISTOPHER",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2008-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "019608-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Massapequa, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.