Active NPI
Jerusalem Vicencio Valdez, PT
- Physical Therapist
- Valley Stream, NY
National Provider Identifier
1053392860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 021867
- Practice address
- 18 Wood LN
Valley Stream, NY 11581-2618 - Phone
- (646) 469-1527
- Fax
- (516) 341-0294
- NPI assigned
- Nov 9, 2005
- Sex
- Female
- Sole proprietor
- Yes
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 | 021867 | NY | Primary |
Addresses
Primary practice location
18 Wood LN
Valley Stream, NY 11581-2618
Mailing address
18 Wood LN
Valley Stream, NY 11581-2618
Phone (646) 469-1527
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459296000000",
"number": "1053392860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 WOOD LN",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115812618",
"telephone_number": "646-469-1527",
"fax_number": "516-341-0294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 WOOD LN",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115812618",
"telephone_number": "646-469-1527",
"fax_number": "516-341-0294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALDEZ",
"first_name": "JERUSALEM",
"middle_name": "VICENCIO",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-11-09",
"last_updated": "2016-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "021867",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Stream, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.