Active NPI
Jonathan Philip Shafer
- Physical Therapy Assistant
- Newburgh, NY
National Provider Identifier
1083205777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 010372-1
- Practice address
- 17 N Plank Rd Ste 10
Newburgh, NY 12550-2111 - Phone
- (845) 800-9305
- NPI assigned
- Jan 27, 2021
- Last updated
- Jan 27, 2021
- Sex
- Male
- 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 Therapy Assistant | 225200000X | 010372-1 | NY | Primary |
Addresses
Primary practice location
17 N Plank Rd Ste 10
Newburgh, NY 12550-2111
Mailing address
1653 Ratzer Rd
Wayne, NJ 07470-2437
Phone (563) 508-4695
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010372-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611705600000",
"number": "1083205777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1653 RATZER RD",
"city": "WAYNE",
"state": "NJ",
"postal_code": "074702437",
"telephone_number": "563-508-4695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 N PLANK RD STE 10",
"city": "NEWBURGH",
"state": "NY",
"postal_code": "125502111",
"telephone_number": "845-800-9305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFER",
"first_name": "JONATHAN",
"middle_name": "PHILIP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-01-27",
"last_updated": "2021-01-27",
"certification_date": "2021-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "010372-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newburgh, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.