Active NPI
Nicholas Angelo Lasarso, DPT
- Physical Therapist
- Queensbury, NY
National Provider Identifier
1063969061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 047240-01
- Practice address
- 2 Country Club Rd
Queensbury, NY 12804-1702 - Phone
- (518) 926-2075
- Fax
- (518) 926-2020
- NPI assigned
- Sep 7, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT4697 | ME | |
| Sports Physical Therapist | 2251S0007X | PT4697 | ME | |
| Orthopedic Physical Therapist | 2251X0800X | PT4697 | ME | |
| Physical Therapist | 225100000X | 047240-01 | NY | Primary |
Addresses
Primary practice location
2 Country Club Rd
Queensbury, NY 12804-1702
Mailing address
2 Country Club Rd
Queensbury, NY 12804-1702
Phone (518) 926-2075
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://intranet.glensfallshosp.org/ | Direct |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047240-01 | NY | MD | Physical Therapist |
| PT4697 | ME | MD | Sports Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629158400000",
"number": "1063969061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 COUNTRY CLUB RD",
"city": "QUEENSBURY",
"state": "NY",
"postal_code": "128041702",
"telephone_number": "518-926-2075",
"fax_number": "518-926-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 COUNTRY CLUB RD",
"city": "QUEENSBURY",
"state": "NY",
"postal_code": "128041702",
"telephone_number": "518-926-2075",
"fax_number": "518-926-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LASARSO",
"first_name": "NICHOLAS",
"middle_name": "ANGELO",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-07",
"last_updated": "2021-08-17",
"certification_date": "2021-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ME",
"license": "PT4697",
"primary": false
},
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": "ME",
"license": "PT4697",
"primary": false
},
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "ME",
"license": "PT4697",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "047240-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://intranet.glensfallshosp.org/",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "2 Country Club Rd",
"city": "Queensbury",
"state": "NY",
"country_code": "US",
"postal_code": "128041702",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Queensbury, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.