Individual provider Active NPI

Jake Scavetta

  • Physical Therapist
  • New York, NY
National Provider Identifier
1093517377
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
049120 Issued in NY
Practice address
210 E 64TH St FL 5
New York, NY 10065-7471
Phone
(212) 434-2700
NPI assigned
Mar 26, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 049120 NY Primary

Addresses

Primary practice location

210 E 64TH St FL 5
New York, NY 10065-7471

Mailing address

972 Brush Hollow Rd FL 4
Westbury, NY 11590-1740
Phone (516) 474-2816

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

LicenseStateTypeSpecialty
049120NYMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1742947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1093517377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "972 BRUSH HOLLOW RD FL 4",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115901740",
            "telephone_number": "516-474-2816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E 64TH ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100657471",
            "telephone_number": "212-434-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCAVETTA",
        "first_name": "JAKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-26",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "049120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; 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.