NPIMap

Organization Active NPI

Island Sports Physical Therapy of Coram PC

  • Physical Therapist
  • Coram, NY
National Provider Identifier
1083681613
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ISLAND SPORTS PHYSICAL THERAPY OF CORAM PC
Practice address
607 Middle Country Road
Coram, NY 11727
Phone
(631) 732-3900
Fax
(631) 732-3900
NPI assigned
Mar 2, 2006
Last updated
Mar 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

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

Authorized official

Name
Kevin Roden, PT OCSNPI 1730154899
Title
Director/Owner
Phone
(631) 732-3900

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 Therapist 225100000X NY Primary

Addresses

Primary practice location

607 Middle Country Road
Coram, NY 11727

Mailing address

607 Middle Country Road
Coram, NY 11727
Phone (631) 732-3900

Other identifiers 3

IdentifierTypeStateIssuer
A384995OtherNYOXFORD
14816OtherNYVYTRA
2C0907OtherNYHEALTHNET

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040320000093 NY Part B Supplier - Clinic/Group Practice 6406747526 Receives reassigned benefits from 6 practitioners
Practice locations: Coram, NY; Selden, NY

National Provider Directory

National Provider Directory

Locations

607 Middle Country Rd
Coram, NY 11727
Phone (516) 732-3900

607 Middle Country Rd
Unit B
Coram, NY 11727
Phone (516) 732-3900

331 Middle Country Rd
Selden, NY 11784
Phone (631) 696-2020

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206921600000",
    "number": "1083681613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 MIDDLE COUNTRY ROAD",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "11727",
            "telephone_number": "631-732-3900",
            "fax_number": "631-732-3908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 MIDDLE COUNTRY ROAD",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "11727",
            "telephone_number": "631-732-3900",
            "fax_number": "631-732-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND SPORTS PHYSICAL THERAPY OF CORAM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-02",
        "last_updated": "2008-03-31",
        "status": "A",
        "authorized_official_last_name": "RODEN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "631-732-3900",
        "authorized_official_credential": "PT OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "A384995",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VYTRA",
            "identifier": "14816",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "2C0907",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coram, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; 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.