Bayside Acupuncture & Physical Therapy PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

034901 Issued in NY

Legal business name

BAYSIDE ACUPUNCTURE & PHYSICAL THERAPY PLLC

Practice address

20801 Northern Blvd Ste 301
Bayside, NY 11361-3118

Phone

(718) 224-2250

Fax

(917) 398-1875

NPI assigned

Jun 4, 2017

Reactivated

Jul 14, 2018

Organization subpart

No

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

Authorized official

Name

Marievic Balaag Ebora Fernando, PT

Title

Managing Member

Phone

(718) 224-2250

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 3

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

• Jaehyun Park

  • Physical Therapist
  • North Bergen, NJ
  • NPI 1114706082

  NY

  Medicare reassignment NPD
• In Kuk Bang, LAC

  • Acupuncturist
  • Bayside, NY
  • NPI 1558890418
  NPD
• Hyohun Kang

  • Acupuncturist
  • Flushing, NY
  • NPI 1164872388
  NPD (past)

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

{
    "created_epoch": "1496534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1205364239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20801 NORTHERN BLVD STE 301",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613118",
            "telephone_number": "718-224-2250",
            "fax_number": "917-398-1875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20801 NORTHERN BLVD STE 301",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613118",
            "telephone_number": "718-224-2250",
            "fax_number": "917-398-1875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSIDE ACUPUNCTURE & PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-04",
        "last_updated": "2022-07-21",
        "certification_date": "2020-02-24",
        "deactivation_date": "2018-05-30",
        "reactivation_date": "2018-07-14",
        "status": "A",
        "authorized_official_last_name": "EBORA FERNANDO",
        "authorized_official_first_name": "MARIEVIC",
        "authorized_official_middle_name": "BALAAG",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "718-224-2250",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "005738",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "034901",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "027555",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bay Terrace Chiropractic, P.C.
• Bay Terrace Medical, PLLC
• Baybridge Optical Visual Eyes Optical Options Inc.
• Baybridge Pharmacy Corp
• Baycare RX Pharmacy Inc
• Bayside Acupuncture Wellness PC
• Bayside Chiropractic, LLC
• Bayside Community Ambulance Corps Inc
• Bayside Dental Arts
• Bayside Dental Associates LLP

• Physical Therapist in Bayside, NY
• Providers in Bayside, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.