NPIMap

Organization Active NPI

Richmond Physical Therapy, PC

  • Physical Therapist
  • Staten Island, NY
National Provider Identifier
1053644153
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
28520-1 Issued in NY
Legal business name
RICHMOND PHYSICAL THERAPY, PC
Practice address
1785 Forest Ave
Staten Island, NY 10303-2107
Phone
(646) 820-5669
NPI assigned
Sep 8, 2009
Last updated
Jul 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Authorized official

Name
Madhurani Prakash MahajanNPI 1285769588
Title
Director
Phone
(646) 820-5669

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
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 28520-1 NY Primary

Addresses

Primary practice location

1785 Forest Ave
Staten Island, NY 10303-2107

Mailing address

1785 Forest Ave
Staten Island, NY 10303-2107
Phone (646) 820-5669

Other practice location 1

158 Main St Ste 100
Matawan, NJ 07747-3178
Phone (646) 820-5669

Other practice location 2

3377 Richmond Ave
Staten Island, NY 10312-2025
Phone (646) 820-5669

Other practice location 3

2627 Hylan Blvd Ste A2
Staten Island, NY 10306-4344
Phone (646) 820-5669

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120308000224 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3577722727 Receives reassigned benefits from 17 practitioners
Practice locations: Staten Island, NY
O20221031002797 NJ Part B Supplier - Clinic/Group Practice 3577722727 Receives reassigned benefits from 3 practitioners
Practice locations: Matawan, NJ

National Provider Directory

National Provider Directory

Locations

1785 Forest Ave
Staten Island, NY 10303
Phone (646) 820-5669

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1053644153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1785 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103032107",
            "telephone_number": "646-820-5669",
            "fax_number": "646-368-8339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1785 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103032107",
            "telephone_number": "646-820-5669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "158 Main St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Matawan",
            "state": "NJ",
            "postal_code": "077473178",
            "country_code": "US",
            "telephone_number": "646-820-5669",
            "fax_number": "646-368-8339",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3377 Richmond Ave",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103122025",
            "country_code": "US",
            "telephone_number": "646-820-5669",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2627 Hylan Blvd Ste A2",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103064344",
            "country_code": "US",
            "telephone_number": "646-820-5669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RICHMOND PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-08",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "MAHAJAN",
        "authorized_official_first_name": "MADHURANI",
        "authorized_official_middle_name": "PRAKASH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "646-820-5669"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "28520-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.