NPIMap

Organization Active NPI

Synergy Physical Therapy & Chiropractic PLLC

  • Chiropractor
  • Corona, NY
National Provider Identifier
1023533437
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X011382 Issued in NY
Legal business name
SYNERGY PHYSICAL THERAPY & CHIROPRACTIC PLLC
Practice address
4304 Junction Blvd Ste B
Corona, NY 11368-2116
Phone
(718) 489-3119
Fax
(718) 889-3119
NPI assigned
Aug 7, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Misty Dickason, DCNPI 1326172693
Title
Chiropractor/Owner
Phone
(718) 701-6490

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X X011382 NY Primary

Addresses

Primary practice location

4304 Junction Blvd Ste B
Corona, NY 11368-2116

Mailing address

10509 Jamaica Ave
Richmond Hill, NY 11418-2014
Phone (718) 489-3119

Other practice location 1

17561 Hillside Ave
Jamaica, NY 11432-5774
Phone (718) 701-6490

Other practice location 2

17561 Hillside Ave
Jamaica, NY 11432-5774
Phone (718) 701-6490

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180711003641 NY Part B Supplier - Clinic/Group Practice 9032465679 Receives reassigned benefits from 2 practitioners
Practice locations: Corona, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1502064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1023533437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10509 JAMAICA AVE",
            "city": "RICHMOND HILL",
            "state": "NY",
            "postal_code": "114182014",
            "telephone_number": "718-489-3119",
            "fax_number": "718-899-3119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4304 JUNCTION BLVD STE B",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682116",
            "telephone_number": "718-489-3119",
            "fax_number": "718-889-3119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17561 Hillside Ave",
            "address_purpose": "LOCATION",
            "city": "Jamaica",
            "state": "NY",
            "postal_code": "114325774",
            "country_code": "US",
            "telephone_number": "718-701-6490",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17561 Hillside Ave",
            "address_purpose": "LOCATION",
            "city": "Jamaica",
            "state": "NY",
            "postal_code": "114325774",
            "country_code": "US",
            "telephone_number": "718-701-6490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SYNERGY PHYSICAL THERAPY & CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-07",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DICKASON",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "CHIROPRACTOR/OWNER",
        "authorized_official_telephone_number": "718-701-6490",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X011382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.