Individual provider Active NPI

Kehinde Ogunrotimi, PT

  • Physical Therapist
  • Great Neck, NY
National Provider Identifier
1134725369
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
046444 Issued in NY
Practice address
475 Northern Blvd Ste 11
Great Neck, NY 11021-4802
Phone
(516) 829-0030
Fax
(516) 466-7723
NPI assigned
Dec 11, 2020
Last updated
Jan 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU
Physical Therapist 225100000X 046444 NY Primary

Addresses

Primary practice location

475 Northern Blvd Ste 11
Great Neck, NY 11021-4802

Mailing address

475 Northern Blvd Ste 11
Great Neck, NY 11021-4802
Phone (516) 829-0030

Other practice location 1

1216 Stanley Ave
Brooklyn, NY 11208-5627
Phone (832) 938-4068

Other practice location 2

309 Northwest Dr
Farmingdale, NY 11735-4935
Phone (516) 420-2900

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Reddy Care Physical Therapy PC Single Specialty CurrentSince Jan 6, 2021 Accepting new patients

Locations

309 Northwest Dr
Farmingdale, NY 11735
Phone (516) 420-2900

27228 Grand Central Pkwy
Floral Park, NY 11005

475 Northern Blvd
Ste 11
Great Neck, NY 11021
Phone (516) 344-0023

Organizations & group practices 1

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": "1607644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1134725369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 NORTHERN BLVD STE 11",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214802",
            "telephone_number": "516-829-0030",
            "fax_number": "516-466-7723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 NORTHERN BLVD STE 11",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214802",
            "telephone_number": "516-829-0030",
            "fax_number": "516-466-7723"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1216 Stanley Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112085627",
            "country_code": "US",
            "telephone_number": "832-938-4068",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "309 Northwest Dr",
            "address_purpose": "LOCATION",
            "city": "Farmingdale",
            "state": "NY",
            "postal_code": "117354935",
            "country_code": "US",
            "telephone_number": "516-420-2900",
            "fax_number": "516-420-2908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OGUNROTIMI",
        "first_name": "KEHINDE",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-11",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "046444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 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.

Verify at the official NPI Registry.