Active NPI
Jerry Charles Neistadt, MSPT
- Physical Therapist
- Melrose, MA
National Provider Identifier
1104027317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10270
- Practice address
- 22 Corey St
Melrose, MA 02176-4621 - Phone
- (781) 979-3165
- Fax
- (781) 979-3189
- NPI assigned
- May 29, 2007
- 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 | 10270 | MA | Primary |
Addresses
Primary practice location
22 Corey St
Melrose, MA 02176-4621
Mailing address
72 Danforth CT
Haverhill, MA 01832-1195
Phone (978) 521-5386
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
| License | State | Type | Specialty |
|---|---|---|---|
| 10270 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104027317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 DANFORTH CT",
"city": "HAVERHILL",
"state": "MA",
"postal_code": "018321195",
"telephone_number": "978-521-5386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 COREY ST",
"city": "MELROSE",
"state": "MA",
"postal_code": "021764621",
"telephone_number": "781-979-3165",
"fax_number": "781-979-3189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEISTADT",
"first_name": "JERRY",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "10270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melrose, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.