Michael Scottodimaso and Tara Derosa, PT, OT, PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0129451 Issued in NY

Legal business name

MICHAEL SCOTTODIMASO AND TARA DEROSA, PT, OT, PLLC

Practice address

51 John St Ste 3
Babylon, NY 11702-2928

Phone

(631) 669-0333

Fax

(631) 669-2436

NPI assigned

Nov 5, 2008

Organization subpart

No

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

Authorized official

Name

Michael Scottodimaso, PTNPI 1497937056

Title

Owner

Phone

(631) 669-0333

Specialties & licenses 2

Addresses

Other names 1

• CBC Ctr for Sports & Physical Therapy Former legal business name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Scottodimaso

  • Physical Therapist
  • Babylon, NY
  • NPI 1497937056
  Medicare reassignment Care Compare group NPD Authorized official
• Tara Marie Derosa

  • Occupational Therapist
  • Bronx, NY
  • NPI 1801530415
  Medicare reassignment Care Compare group NPD
• Gregory J Beach, PT

  • Specialist
  • Smithtown, NY
  • NPI 1568493260
  NPD (past)
• Alfonse Coppola, PT

  • Physical Therapist
  • Babylon, NY
  • NPI 1962580126
  NPD (past)
• Gary L Foster, PT

  • Specialist
  • Smithtown, NY
  • NPI 1386675080
  NPD (past)

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773964800000",
    "number": "1154575074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 JOHN ST STE 3",
            "city": "BABYLON",
            "state": "NY",
            "postal_code": "117022928",
            "telephone_number": "631-669-0333",
            "fax_number": "631-669-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 JOHN ST STE 3",
            "city": "BABYLON",
            "state": "NY",
            "postal_code": "117022928",
            "telephone_number": "631-669-0333",
            "fax_number": "631-669-2436"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Massapequa",
            "state": "NY",
            "postal_code": "117584905",
            "country_code": "US",
            "telephone_number": "631-669-0333",
            "fax_number": "631-669-2436",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5500 Merrick Rd",
            "address_purpose": "LOCATION",
            "city": "Massapequa",
            "state": "NY",
            "postal_code": "117586231",
            "country_code": "US",
            "telephone_number": "631-669-0333",
            "fax_number": "631-669-2436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MICHAEL SCOTTODIMASO AND TARA DEROSA, PT, OT, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2026-03-20",
        "certification_date": "2026-03-20",
        "status": "A",
        "authorized_official_last_name": "SCOTTODIMASO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-669-0333",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "0129451",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CBC Ctr for Sports & Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kerri Mendoza, LPN
• Kevin G Mescall
• Vasilios Dimetrios Mesimeris, DMD
• Marc Messineo, D.O.
• Metro Therapy
• Kimberly Joy Mickowski, MS, CCC/SLP, TSHH
• Victoria Theresa Mienert
• Yaroslava Lana Mihle, ACUPUNTURE
• Angela Marie Milio, OTR/L
• John Joseph Milone II, DC

• Physical Therapist in Babylon, NY
• Providers in Babylon, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2026; 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.