Individual provider Active NPI

Jaclyn Primiano, OTR/L

  • Occupational Therapist
  • New York, NY
National Provider Identifier
1104061381
Registry record updated Dec 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
012568-1 Issued in NY
Practice address
320 E 65TH St
Suite 117
New York, NY 10065-6743
Phone
(212) 249-2588
NPI assigned
Dec 2, 2008
Last updated
Dec 2, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 012568-1 NY Primary

Addresses

Primary practice location

320 E 65TH St
Suite 117
New York, NY 10065-6743

Mailing address

320 E 65TH St
Suite 117
New York, NY 10065-6743

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241023002604 NY Practitioner - Occupational Therapist in Private Practice 5496288979 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

801 Merrick Ave
East Meadow, NY 11554-4748
Phone (516) 393-8900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
012568-1NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic Occupational Therapist CurrentSince Oct 1, 2024 Accepting new patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic Occupational Therapist CurrentSince Oct 1, 2024 Accepting new patients
Making Milestones Past Accepting new patients
Lori Golden Ma-CCC, SLP & Robin Bump, PT PLLC Past Accepting new patients

Locations

801 Merrick Ave
East Meadow, NY 11554
Phone (516) 393-8900

9525 Queens Blvd
Ste 3D
Rego Park, NY 11374
Phone (718) 925-6212

972 Brush Hollow Rd
Fl 4
Westbury, NY 11590
Phone (516) 321-7526

Organizations & group practices 4

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": "1228176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228176000000",
    "number": "1104061381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 E 65TH ST",
            "address_2": "SUITE 117",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100656743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 E 65TH ST",
            "address_2": "SUITE 117",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100656743",
            "telephone_number": "212-249-2588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIMIANO",
        "first_name": "JACLYN",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-02",
        "last_updated": "2008-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "012568-1",
            "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 Dec 2, 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.