Individual provider Active NPI

John Edwin Burk, PT

  • Physical Therapist
  • Lagrangeville, NY
National Provider Identifier
1154419216
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
016283 1 Issued in NY
Practice address
1100 Route 55
Suite 101
Lagrangeville, NY 12540-5017
Phone
(845) 471-2423
Fax
(845) 471-2776
NPI assigned
Oct 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 016283 1 NY Primary

Addresses

Primary practice location

1100 Route 55
Suite 101
Lagrangeville, NY 12540-5017

Mailing address

30 Forest Valley Rd
Pleasant Valley, NY 12569-7609

Other identifiers 1

IdentifierTypeStateIssuer
016283 1OtherNYSTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111020000512 NY Practitioner - Physical Therapist in Private Practice 2163588310 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016283 1NYMDPhysical Therapist
016283NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pleasant Valley Physical Therapy LLC Physical Therapist CurrentSince Jan 1, 1999 Accepting new patients
Pleasant Valley Physical Therapy Physical Therapist Current Accepting new patients

Locations

1100 Route 55
Ste 101
Lagrangeville, NY 12540
Phone (845) 471-2423

761 Freedom Plains Rd
Poughkeepsie, NY 12603
Phone (845) 471-2423

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154419216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 FOREST VALLEY RD",
            "city": "PLEASANT VALLEY",
            "state": "NY",
            "postal_code": "125697609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 ROUTE 55",
            "address_2": "SUITE 101",
            "city": "LAGRANGEVILLE",
            "state": "NY",
            "postal_code": "125405017",
            "telephone_number": "845-471-2423",
            "fax_number": "845-471-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURK",
        "first_name": "JOHN",
        "middle_name": "EDWIN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "016283 1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "016283 1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrangeville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.