Organization Active NPI

Momentum Physical & Occupational Therapy, PLLC

  • Occupational Therapist
  • Bronx, NY
National Provider Identifier
1053153106
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
MOMENTUM PHYSICAL & OCCUPATIONAL THERAPY, PLLC
Practice address
1870 Grand Concourse FL 2
Bronx, NY 10457-5476
Phone
(929) 412-9527
NPI assigned
Jun 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Authorized official

Name
Clyde Matthew Labial, OTR/LNPI 1245928936
Title
Occupational Therapist
Phone
(929) 412-9527

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

1870 Grand Concourse FL 2
Bronx, NY 10457-5476

Mailing address

16414 Goethals Ave
Jamaica, NY 11432-1224

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240711001678 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3779028022 Receives reassigned benefits from 1 practitioner
Practice locations: Bronx, NY

National Provider Directory

National Provider Directory

Locations

1870 Grand Concourse
Fl 2
Bronx, NY 10457
Phone (347) 431-3824

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1053153106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16414 GOETHALS AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870 GRAND CONCOURSE FL 2",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104575476",
            "telephone_number": "929-412-9527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMENTUM PHYSICAL & OCCUPATIONAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "LABIAL",
        "authorized_official_first_name": "CLYDE MATTHEW",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "929-412-9527",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; 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.