Organization Active NPI

Occupational Therapy Nest PLLC

  • Occupational Therapist
  • Rego Park, NY
National Provider Identifier
1144993338
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
OCCUPATIONAL THERAPY NEST PLLC
Practice address
9508 Queens Blvd Ste 1E
Rego Park, NY 11374-1151
Phone
(718) 275-2669
NPI assigned
Jul 26, 2021
Last updated
Jul 26, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

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

Authorized official

Name
Mikhail Ilyasov, OTR/LNPI 1780260018
Title
Director
Phone
(718) 612-5634

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
Occupational Therapist 225X00000X NU Primary

Addresses

Primary practice location

9508 Queens Blvd Ste 1E
Rego Park, NY 11374-1151

Mailing address

14765 Hoover Ave
Jamaica, NY 11435-2139
Phone (718) 612-5634

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210920003385 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4880091701 Receives reassigned benefits from 3 practitioners
Practice locations: Brooklyn, NY; Rego Park, NY
O20260519000754 NY DME Supplier - Independently-Practicing Occupational Therapist 4880091701 Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

2919 Avenue S
Ste Ot
Brooklyn, NY 11229
Phone (718) 612-5634

9508 Queens Blvd
Ste 1E
Rego Park, NY 11374
Phone (718) 275-2669

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627257600000",
    "number": "1144993338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14765 HOOVER AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114352139",
            "telephone_number": "718-612-5634",
            "fax_number": "718-275-2686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9508 QUEENS BLVD STE 1E",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113741151",
            "telephone_number": "718-275-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCCUPATIONAL THERAPY NEST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-26",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A",
        "authorized_official_last_name": "ILYASOV",
        "authorized_official_first_name": "MIKHAIL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "718-612-5634",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; 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.