Venkatesan Sivaraman, P.T.
Individual provider Active NPI Specialist · Bellerose Terrace, NY
NPI 1154522258 · NPPES record last updated Mar 20, 2025
Key facts
- NPI
- 1154522258
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 0170691 (NY)
- Practice address
- 248-22 Jericho Turnpike
Bellerose Terrace, NY 11001-4002 - Phone
- (516) 850-1285
- Fax
- (855) 635-6565
- NPI assigned
- May 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
24822 Jericho Tpke
Floral Park, NY 11001-4002
Phone (516) 673-4161
2965 Long Beach Rd
Oceanside, NY 11572-3255
Phone (516) 673-4161
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140102000062 | NY | Practitioner - Physical Therapist in Private Practice | 7618103466 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0170691 | NY | MD | Speech-Language Pathologist |
Practice roles (2 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Main Street Physical Therapy PC | Current |
Accepting new patients | |
| Mark S. Plante | Past | Accepting new patients |
Locations
24822 Jericho Tpke
Floral Park, NY 11001
Phone (516) 673-4161
2965 Long Beach Rd
Oceanside, NY 11572
Phone (516) 593-8953
10611 101st Ave
Ozone Park, NY 11416
Phone (516) 850-1285
558 Old Country Rd
Plainview, NY 11803
Phone (516) 605-1212
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 0170691 | NY | Yes |
Addresses
Primary practice location
248-22 Jericho Turnpike
Bellerose Terrace, NY 11001-4002
Mailing address
248-22 Jericho Turnpike
Bellerose Terrace, NY 11001-4002
Phone (516) 850-1285
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.