NPIMap

Organization Active NPI

Promet Physical Therapy, PC

  • Physical Therapist
  • Kew Gardens, NY
National Provider Identifier
1164738936
Registry record updated Aug 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
028654 Issued in NY
Legal business name
PROMET PHYSICAL THERAPY, PC
Practice address
12308 Metropolitan Ave
Kew Gardens, NY 11415-2710
Phone
(718) 880-2385
Fax
(718) 880-2386
NPI assigned
Aug 31, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2010

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

Authorized official

Name
Julian Samodulski, PT, DPTNPI 1437356987
Title
Partner
Phone
(718) 880-2385

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 028654 NY Primary

Addresses

Primary practice location

12308 Metropolitan Ave
Kew Gardens, NY 11415-2710

Mailing address

6317 Metropolitan Ave
Middle Village, NY 11379-1606
Phone (718) 554-6610

National Provider Directory

National Provider Directory
Tax ID family
Promet Physical Therapy PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12308 Metropolitan Ave
Kew Gardens, NY 11415
Phone (718) 880-2385

6317 Metropolitan Ave
Middle Village, NY 11379
Phone (718) 360-4908

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283212800000",
    "number": "1164738936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6317 METROPOLITAN AVE",
            "city": "MIDDLE VILLAGE",
            "state": "NY",
            "postal_code": "113791606",
            "telephone_number": "718-554-6610",
            "fax_number": "718-360-4908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12308 METROPOLITAN AVE",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114152710",
            "telephone_number": "718-880-2385",
            "fax_number": "718-880-2386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMET PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-31",
        "last_updated": "2010-08-31",
        "status": "A",
        "authorized_official_last_name": "SAMODULSKI",
        "authorized_official_first_name": "JULIAN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "718-880-2385",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "028654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kew Gardens, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.