NPIMap

Organization Active NPI

Forward Physical Therapy, PLLC

  • Physical Therapy Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1093082604
Registry record updated Jul 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
029579 Issued in NY
Legal business name
FORWARD PHYSICAL THERAPY, PLLC
Practice address
1716 Coney Island Ave
Brooklyn, NY 11230
Phone
(718) 336-4900
Fax
(718) 336-4990
NPI assigned
Nov 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2019

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

Authorized official

Name
David Jay Ettinger, PTNPI 1629262993
Title
Owner
Phone
(718) 336-4900

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 Therapy Clinic/Center 261QP2000X 029579 NY Primary

Addresses

Primary practice location

1716 Coney Island Ave
Brooklyn, NY 11230

Mailing address

1565 E 36TH St
Brooklyn, NY 11234-3415
Phone (917) 658-7726

Other practice location 1

3815 13th Avenue
Brooklyn, NY 11218
Phone (708) 677-6777

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120221000806 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1557529682 Receives reassigned benefits from 6 practitioners
Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

3815 13th Ave
Brooklyn, NY 11218
Phone (708) 677-6777

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1322438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562112000000",
    "number": "1093082604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1565 E 36TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112343415",
            "telephone_number": "917-658-7726",
            "fax_number": "718-682-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1716 CONEY ISLAND AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11230",
            "telephone_number": "718-336-4900",
            "fax_number": "718-336-4990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3815 13th Avenue",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11218",
            "country_code": "US",
            "telephone_number": "708-677-6777",
            "fax_number": "718-682-0707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FORWARD PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-28",
        "last_updated": "2019-07-03",
        "status": "A",
        "authorized_official_last_name": "ETTINGER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-336-4900",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "029579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2019; 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.