East Meadow PT Family Health NP Acupuncture and Chiropractic

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

EAST MEADOW PT FAMILY HEALTH NP ACUPUNCTURE AND CHIROPRACTIC

Doing business as

East Meadow PTDC

Practice address

2103 Deer Park Ave
Deer Park, NY 11729-1317

Phone

(631) 242-4500

Fax

(631) 242-0885

NPI assigned

Jun 17, 2019

Organization subpart

No

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

Authorized official

Name

Jack James Tesoriero

Title

Owner

Phone

(631) 242-4500

Specialties & licenses 4

Addresses

Other names 1

• East Meadow PTDC Doing business as

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585526400000",
    "number": "1235799883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 DEER PARK AVE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117291317",
            "telephone_number": "631-242-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 DEER PARK AVE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117291317",
            "telephone_number": "631-242-4500",
            "fax_number": "631-242-0885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2120 Hempstead Tpke",
            "address_purpose": "LOCATION",
            "city": "East Meadow",
            "state": "NY",
            "postal_code": "115541803",
            "country_code": "US",
            "telephone_number": "516-794-0414",
            "fax_number": "516-794-0434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST MEADOW PT FAMILY HEALTH NP ACUPUNCTURE AND CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-17",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A",
        "authorized_official_last_name": "TESORIERO",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-242-4500"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Meadow PTDC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Meadow PTDC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kayla Edwards, BSW
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• Physical Therapist in Deer Park, NY
• Providers in Deer Park, 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 Mar 30, 2020; 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.