NPIMap

Organization Active NPI

Dynamic Physical Therapy Rehab of Ny P.C.

  • Physical Therapy Clinic/Center
  • Mineola, NY
National Provider Identifier
1134775174
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
DYNAMIC PHYSICAL THERAPY REHAB OF NY P.C.
Practice address
157 Andrews Rd
Mineola, NY 11501-2345
Phone
(213) 884-5987
Fax
(718) 228-7628
NPI assigned
Aug 15, 2019
Last updated
Oct 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Authorized official

Name
Kinchin NonogNPI 1346617214
Title
Owner
Phone
(213) 884-5987

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

157 Andrews Rd
Mineola, NY 11501-2345

Mailing address

157 Andrews Rd
Mineola, NY 11501-2345
Phone (213) 884-5987

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190917003945 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1759611759 Receives reassigned benefits from 19 practitioners
Practice locations: Mineola, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728604800000",
    "number": "1134775174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 ANDREWS RD",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115012345",
            "telephone_number": "213-884-5987",
            "fax_number": "718-228-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 ANDREWS RD",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115012345",
            "telephone_number": "213-884-5987",
            "fax_number": "718-228-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PHYSICAL THERAPY REHAB OF NY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-15",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A",
        "authorized_official_last_name": "NONOG",
        "authorized_official_first_name": "KINCHIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "213-884-5987"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; 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.