Individual provider Active NPI

Lydia Marie Espaillat, DPT

  • Physical Therapist
  • Island Park, NY
National Provider Identifier
1164248456
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
053630-01 Issued in NY
Practice address
3961 Long Beach Rd
Island Park, NY 11558-1127
Phone
(516) 897-9700
NPI assigned
Dec 2, 2024
Last updated
Dec 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

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 053630-01 NY Primary

Addresses

Primary practice location

3961 Long Beach Rd
Island Park, NY 11558-1127

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224
Phone (142) 944-0509

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241211002404 NY Practitioner - Physical Therapist in Private Practice 3870029051 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1311 Mamaroneck Ave
Suite 140
White Plains, NY 10605-5224

3961 Long Beach Rd
Island Park, NY 11558-1127
Phone (516) 897-9700

550 Mamaroneck Ave
Suite 104
Harrison, NY 10528-1612
Phone (914) 777-3737

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
053630NYMDDentist
053630-01NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC CurrentSince Dec 9, 2024 Accepting new patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path Physical Therapist CurrentSince Dec 9, 2024 Accepting new patients

Locations

550 Mamaroneck Ave
Ste 104
Harrison, NY 10528
Phone (914) 777-3737

3961 Long Beach Rd
Island Park, NY 11558
Phone (516) 599-8734

1311 Mamaroneck Ave
Ste 140
White Plains, NY 10605
Phone (914) 265-4838

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1733097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1164248456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "142-944-0509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3961 LONG BEACH RD",
            "city": "ISLAND PARK",
            "state": "NY",
            "postal_code": "115581127",
            "telephone_number": "516-897-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESPAILLAT",
        "first_name": "LYDIA",
        "middle_name": "MARIE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-02",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "053630-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Island Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.