Active NPI
Vincent Riedel
- Massage Therapist
- Miller Place, NY
National Provider Identifier
1104595776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 019235
- Practice address
- 15 Sunwood Drive
Miller Place, NY 11764 - Phone
- (919) 726-4774
- NPI assigned
- Sep 8, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 019235 | NY | Primary |
Addresses
Primary practice location
15 Sunwood Drive
Miller Place, NY 11764
Mailing address
15 Sunwood Drive
Miller Place, NY 11764
Phone (919) 726-4774
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 |
|---|---|---|---|
| 019235 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631059200000",
"number": "1104595776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 SUNWOOD DRIVE",
"city": "MILLER PLACE",
"state": "NY",
"postal_code": "11764",
"telephone_number": "919-726-4774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 SUNWOOD DRIVE",
"city": "MILLER PLACE",
"state": "NY",
"postal_code": "11764",
"telephone_number": "919-726-4774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIEDEL",
"first_name": "VINCENT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-09-08",
"last_updated": "2021-09-08",
"certification_date": "2021-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "019235",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miller Place, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.