Active NPI
Iluminado Nirza Jr., PT
- Physical Therapist
- Brentwood, NY
National Provider Identifier
1093046146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1273000
- Practice address
- 55 Second Avenue
Brentwood, NY 11717 - Phone
- (631) 617-5733
- NPI assigned
- Jan 28, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1273000 | TX | Primary |
Addresses
Primary practice location
55 Second Avenue
Brentwood, NY 11717
Mailing address
5080 Spectrum Dr
Ste 1200W
Addison, TX 75001-4624
Phone (972) 364-8000
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 |
|---|---|---|---|
| 028048 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490227200000",
"number": "1093046146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5080 SPECTRUM DR",
"address_2": "STE 1200W",
"city": "ADDISON",
"state": "TX",
"postal_code": "750014624",
"telephone_number": "972-364-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 SECOND AVENUE",
"city": "BRENTWOOD",
"state": "NY",
"postal_code": "11717",
"telephone_number": "631-617-5733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIRZA",
"first_name": "ILUMINADO",
"name_suffix": "Jr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-28",
"last_updated": "2017-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1273000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brentwood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.