NPIMap

Organization Active NPI

Prohealth and Fitness PT OT PLLC

  • Physical Therapist
  • New York, NY
National Provider Identifier
1124344650
Registry record updated Oct 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
020992 Issued in NY
Legal business name
PROHEALTH AND FITNESS PT OT PLLC
Practice address
180 W End Ave Apt 1M
New York, NY 10023-4917
Phone
(212) 600-4781
Fax
(800) 655-3780
NPI assigned
Apr 8, 2010
Last updated
Oct 26, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2010

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

Authorized official

Name
Dr. James Nussbaum, PHD, MSPT, SCS, EMTNPI 1588682686
Title
Clinical Director, Owner
Phone
(212) 600-4781

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 020992 NY Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 007313 NY

Addresses

Primary practice location

180 W End Ave Apt 1M
New York, NY 10023-4917

Mailing address

180 W End Ave Apt 1M
New York, NY 10023-4917
Phone (212) 600-4781

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101028000663 NY Part B Supplier - Clinic/Group Practice 4284828757 Receives reassigned benefits from 36 practitioners
Practice locations: New York, NY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pro Health and Fitness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1041 3rd Ave
Ste D
New York, NY 10065
Phone (212) 600-4781

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1270684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288051200000",
    "number": "1124344650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 W END AVE APT 1M",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100234917",
            "telephone_number": "212-600-4781",
            "fax_number": "800-655-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 W END AVE APT 1M",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100234917",
            "telephone_number": "212-600-4781",
            "fax_number": "800-655-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH AND FITNESS PT OT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-08",
        "last_updated": "2010-10-26",
        "status": "A",
        "authorized_official_last_name": "NUSSBAUM",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR, OWNER",
        "authorized_official_telephone_number": "212-600-4781",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, MSPT, SCS, EMT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "020992",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "007313",
            "primary": false
        }
    ],
    "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 Oct 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.