Individual provider Active NPI

Ilene M Goldberg, OT

  • Occupational Therapist
  • New City, NY
National Provider Identifier
1164551453
Registry record updated Aug 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
007890-1 Issued in NY
Practice address
260 N Little Tor Rd
New City, NY 10956-2627
Phone
(845) 708-2000
NPI assigned
Mar 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 007890-1 NY Primary

Addresses

Primary practice location

260 N Little Tor Rd
New City, NY 10956-2627

Mailing address

260 Little Tor Road
New City, NY 10956
Phone (845) 708-2000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130910000944 NY Practitioner - Occupational Therapist in Private Practice 7719121995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Mercy College, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jawonio IncGroup PAC ID 8628227683, 12 clinicians

Practice addresses (Care Compare)

260 N Little Tor Rd
New City, NY 10956-2627
Phone (845) 708-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
007890-1NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jawonio Inc CurrentSince Sep 1, 2013 Accepting new patients
Jawonio Inc Current Accepting new patients
Jawonio Inc CurrentSince Sep 1, 2013 Accepting new patients

Locations

260 N Little Tor Rd
New City, NY 10956
Phone (845) 634-4648

260 N Little Tor Rd
#D
New City, NY 10956
Phone (845) 708-2000

775 N Main St
#D
Spring Valley, NY 10977
Phone (845) 708-2000

Organizations & group practices 3

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": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1164551453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 LITTLE TOR ROAD",
            "city": "NEW CITY",
            "state": "NY",
            "postal_code": "10956",
            "telephone_number": "845-708-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 N LITTLE TOR RD",
            "city": "NEW CITY",
            "state": "NY",
            "postal_code": "109562627",
            "telephone_number": "845-708-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBERG",
        "first_name": "ILENE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "007890-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; 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.