Individual provider Active NPI

Robert Pesci, DPT

  • Specialist
  • Massapequa, NY
National Provider Identifier
1093905531
Registry record updated Jul 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
029487-1 Issued in NY
Practice address
1061 N Broadway
Massapequa, NY 11758-1802
Phone
(516) 454-6387
Fax
(516) 454-6303
NPI assigned
Jul 31, 2007
Last updated
Jul 10, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 029487-1 NY Primary

Addresses

Primary practice location

1061 N Broadway
Massapequa, NY 11758-1802

Mailing address

1061 N Broadway
Massapequa, NY 11758-1802
Phone (516) 454-6387

Other identifiers 1

IdentifierTypeStateIssuer
11859214OtherNYCAQH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070908000074 NY Practitioner - Physical Therapist in Private Practice 1153413653 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

256 N Wellwood Ave
Lindenhurst, NY 11757-3707
Phone (631) 957-7300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
029487-1NYMDSpecialist
029487NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Massapequa PT & Pta PLLC CurrentSince May 1, 2020 Accepting new patients
Medcare Therapy Services:Physical, Occupational & Massage Therapy,PLLC CurrentSince Oct 20, 2010 Accepting new patients
Lindenhurst PT & Pta PLLC CurrentSince Feb 10, 2010 Accepting new patients
Sherrie Glasser Physical Therapy/John Douglas Pta Specialist Past Accepting new patients
Speonk Physical Therapy PastSince May 26, 2009 Accepting new patients
Plainview Physical Therapy, PC PastSince Nov 8, 2000 Accepting new patients

Locations

2848 Middle Country Rd
Lake Grove, NY 11755
Phone (631) 648-8835

256 N Wellwood Ave
Lindenhurst, NY 11757
Phone (631) 226-3380

1061 N Broadway
North Massapequa, NY 11758
Phone (516) 420-4300

913 N Broadway
North Massapequa, NY 11758
Phone (516) 454-6387

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1185840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215648000000",
    "number": "1093905531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 N BROADWAY",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117581802",
            "telephone_number": "516-454-6387",
            "fax_number": "516-454-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 N BROADWAY",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117581802",
            "telephone_number": "516-454-6387",
            "fax_number": "516-454-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PESCI",
        "first_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-31",
        "last_updated": "2008-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "029487-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11859214",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Massapequa, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.