NPIMap

Organization Active NPI

Fresh Pond Physical Therapy Jackson Heights, PC.

  • Physical Therapist
  • Jackson Heights, NY
National Provider Identifier
1093111023
Registry record updated May 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
FRESH POND PHYSICAL THERAPY JACKSON HEIGHTS, PC.
Practice address
9216 Roosevelt Ave
Jackson Heights, NY 11372-7942
Phone
(718) 456-2545
Fax
(718) 559-6784
NPI assigned
Nov 19, 2014
Last updated
May 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2016

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

Authorized official

Name
Liza TanNPI 1982628764
Title
President
Phone
(718) 456-2545

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NY Primary

Addresses

Primary practice location

9216 Roosevelt Ave
Jackson Heights, NY 11372-7942

Mailing address

6805 Fresh Pond Rd
Ridgewood, NY 11385-5200
Phone (718) 456-2543

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1416355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463702400000",
    "number": "1093111023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6805 FRESH POND RD",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113855200",
            "telephone_number": "718-456-2543",
            "fax_number": "718-559-6784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9216 ROOSEVELT AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727942",
            "telephone_number": "718-456-2545",
            "fax_number": "718-559-6784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH POND PHYSICAL THERAPY JACKSON HEIGHTS, PC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-19",
        "last_updated": "2016-05-20",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "LIZA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-456-2545"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.