Individual provider Active NPI

Charles Michael Pablo, PT

  • Physical Therapist
  • New York, NY
National Provider Identifier
1063941029
Registry record updated Jul 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA02406000 Issued in NJ
Practice address
115 E 57TH St Ste 520
New York, NY 10022-2221
Phone
(212) 755-5500
NPI assigned
Jun 5, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 24, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40QA02406000 NJ Primary
Physical Therapist 225100000X 041396 NY

Addresses

Primary practice location

115 E 57TH St Ste 520
New York, NY 10022-2221

Mailing address

13 Mair Ave
Totowa, NJ 07512-2312
Phone (201) 889-0119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190718002650 NY Practitioner - Physical Therapist in Private Practice 9032444617 Reassigns benefits to 2 organizations
I20221107001688 NM Practitioner - Physical Therapist in Private Practice 9032444617 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041369NYMDPharmacist
041396NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Therapy at Dawn, LLC Physical Therapist CurrentSince Oct 31, 2022 Accepting new patients
Stern at Home Physical Therapy PC Physical Therapist CurrentSince May 19, 2024 Accepting new patients
Metro Physical Occupational Speech Massage Therapy & Acupuncture PLLC Physical Therapist CurrentSince Apr 24, 2024 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

3611 NM 528 NW
Ste 101
Albuquerque, NM 87114
Phone (505) 217-2826

6330 Riverside Plaza Ln NW
Albuquerque, NM 87120
Phone (505) 312-7930

4080 Hempstead Tpke
Bethpage, NY 11714
Phone (516) 738-4844

800 E Gate Blvd
Garden City, NY 11530

50 Glen Cove Rd
Greenvale, NY 11548
Phone (516) 200-3545

4 Medical Park Dr
Ste B
Pomona, NY 10970
Phone (845) 354-3131

11701 84th Ave
Richmond Hill, NY 11418
Phone (718) 441-0300

1312 Middle Country Rd
Selden, NY 11784
Phone (631) 698-6556

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1496620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784851200000",
    "number": "1063941029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 MAIR AVE",
            "city": "TOTOWA",
            "state": "NJ",
            "postal_code": "075122312",
            "telephone_number": "201-889-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E 57TH ST STE 520",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100222221",
            "telephone_number": "212-755-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PABLO",
        "first_name": "CHARLES",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-05",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02406000",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "041396",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2026; 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.