Individual provider Active NPI

Anatoli Yoshovayev, P.T.

  • Physical Therapist
  • Fresh Meadows, NY
National Provider Identifier
1104095777
Registry record updated Dec 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
029274 Issued in NY
Practice address
7340 172ND St
Fresh Meadows, NY 11366-1421
Phone
(718) 291-1513
NPI assigned
Feb 27, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2018

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 029274 NY Primary

Addresses

Primary practice location

7340 172ND St
Fresh Meadows, NY 11366-1421

Mailing address

7340 172ND St
Fresh Meadows, NY 11366-1421
Phone (718) 850-6345

Other identifiers 2

IdentifierTypeStateIssuer
262275638OtherNYTAX ID
G300000050OtherNYMEDICARE GHI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080724000455 NY Practitioner - Physical Therapist in Private Practice 7214000223 Practice locations: Fresh Meadows, NY
I20091014000436 NJ Practitioner - Physical Therapist in Private Practice 7214000223 Reassigns benefits to 1 organization

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)

47 Orient Way
Rutherford, NJ 07070-2040
Phone (973) 910-0307

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
029274NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dynamic Rehab P T PC Physical Therapist CurrentSince Jul 15, 2011 Accepting new patients
Ib Family Medical PC Past Accepting new patients
Neuromuscular Physical Therapy P.C. Past Accepting new patients

Locations

316 N 6th St
Prospect Park, NJ 07508
Phone (201) 200-1616

47 Orient Way
Fl 2C
Rutherford, NJ 07070
Phone (973) 910-0307

55 Meadowlands Pkwy
Fl 3
Secaucus, NJ 07094
Phone (201) 392-3588

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545004800000",
    "number": "1104095777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7340 172ND ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113661421",
            "telephone_number": "718-850-6345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7340 172ND ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113661421",
            "telephone_number": "718-291-1513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOSHOVAYEV",
        "first_name": "ANATOLI",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-27",
        "last_updated": "2018-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "029274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "262275638",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GHI",
            "identifier": "G300000050",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresh Meadows, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; 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.