NPIMap

Organization Active NPI

St Judes PT

  • Pediatric Physical Therapist
  • Brooklyn, NY
National Provider Identifier
1205118429
Registry record updated Sep 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
028641 Issued in NY
Legal business name
ST JUDES PT
Doing business as
St Judes PT- Pediatric Services
Practice address
212 Macon St
2ND Floor
Brooklyn, NY 11216-2405
Phone
(718) 238-0311
NPI assigned
Sep 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2011

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

Authorized official

Name
Dr. Keisha E John, DPT
Title
Owner
Phone
(718) 238-0311

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251P0200X 028641 NY Primary
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X 015866 NY
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X NY

Addresses

Primary practice location

212 Macon St
2ND Floor
Brooklyn, NY 11216-2405

Mailing address

7712 4TH Ave
First Floor
Brooklyn, NY 11209-3402
Phone (718) 238-0311

Other names 1

  • St Judes PT- Pediatric Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Jude'S Pediatric Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

7712 4th Ave
Fl First
Brooklyn, NY 11209

NPI Registry JSON

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

{
    "created_epoch": "1315958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315958400000",
    "number": "1205118429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7712 4TH AVE",
            "address_2": "FIRST FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112093402",
            "telephone_number": "718-238-0311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 MACON ST",
            "address_2": "2ND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112162405",
            "telephone_number": "718-238-0311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDES PT",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-14",
        "last_updated": "2011-09-14",
        "status": "A",
        "authorized_official_last_name": "JOHN",
        "authorized_official_first_name": "KEISHA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-238-0311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NY",
            "license": "028641",
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NY",
            "license": "015866",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Judes PT- Pediatric Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2011; 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.