Individual provider Active NPI

Sherwin C Paller, PT

  • Physical Therapist
  • Brooklyn, NY
National Provider Identifier
1053609156
Registry record updated Jul 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
031641 Issued in NY
Practice address
1200 Gravesend Neck Rd
LC
Brooklyn, NY 11229-4256
Phone
(718) 502-9860
NPI assigned
Jul 11, 2011
Last updated
Jul 11, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 031641 NY Primary

Addresses

Primary practice location

1200 Gravesend Neck Rd
LC
Brooklyn, NY 11229-4256

Mailing address

1656 E 12TH St
2ND FL
Brooklyn, NY 11229-1012
Phone (718) 998-3020

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111123000378 NY Practitioner - Physical Therapist in Private Practice 7416121728 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Leena Physical Therapy PC Physical Therapist Past Accepting new patients
Mission Rehab PT PC Physical Therapist PastSince Sep 19, 2011 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310342400000",
    "number": "1053609156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1656 E 12TH ST",
            "address_2": "2ND FL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291012",
            "telephone_number": "718-998-3020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 GRAVESEND NECK RD",
            "address_2": "LC",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112294256",
            "telephone_number": "718-502-9860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALLER",
        "first_name": "SHERWIN",
        "middle_name": "C",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-11",
        "last_updated": "2011-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "031641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; 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.