Provider Rehab, OT. P.C.

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

63018851 Issued in NY

Legal business name

PROVIDER REHAB, OT. P.C.

Practice address

288 Sand LN Ste 1
Staten Island, NY 10305-4512

Phone

(347) 766-9077

NPI assigned

Feb 1, 2016

Last updated

Mar 5, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Dmitry Shevchenko, OTR/LNPI 1578974473

Title

President

Phone

(347) 766-9077

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dmitry Shevchenko, OTR/L

  • Occupational Therapist
  • Brooklyn, NY
  • NPI 1578974473
  Medicare reassignment NPD Authorized official
• Vyacheslav Glukh

  • Single Specialty Group
  • Staten Island, NY
  • NPI 1447689179
  Medicare reassignment NPD
• Mikhail Ilyasov, OTR/L

  • Occupational Therapist
  • Rego Park, NY
  • NPI 1780260018
  Medicare reassignment NPD
• Judy Lin

  • Occupational Therapist
  • Forest Hills, NY
  • NPI 1477887263
  Medicare reassignment NPD
• Alejandra Montejo

  • Occupational Therapist
  • New York, NY
  • NPI 1376091835
  Medicare reassignment NPD
• Heidi Richter, OTR/L

  • Occupational Therapist
  • New York, NY
  • NPI 1265071625
  Medicare reassignment NPD
• Jason Sarzosa

  • Occupational Therapist
  • Elmhurst, NY
  • NPI 1144623695
  Medicare reassignment NPD

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

{
    "created_epoch": "1454284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1205294691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 EMMONS AVE APT 5T",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112352228",
            "telephone_number": "347-766-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "288 SAND LN STE 1",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103054512",
            "telephone_number": "347-766-9077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3030 Emmons Ave Apt 5T",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112352228",
            "country_code": "US",
            "telephone_number": "347-766-9077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDER REHAB, OT. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-01",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "SHEVCHENKO",
        "authorized_official_first_name": "DMITRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "347-766-9077",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "63018851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Occupational Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; 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.