Active NPI
Jeremy Park, PT, DPT, CSCS
- Orthopedic Physical Therapist
- Oswego, NY
National Provider Identifier
1245057280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 052956
- Practice address
- 110 W 6TH St
Oswego, NY 13126-2507 - Phone
- (315) 345-1262
- NPI assigned
- Sep 23, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 052956 | NY | Primary |
Addresses
Primary practice location
110 W 6TH St
Oswego, NY 13126-2507
Mailing address
5511 Legionnaire Dr Apt 206
Cicero, NY 13039-3517
Phone (315) 345-1262
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052956 | NY | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727049600000",
"number": "1245057280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5511 LEGIONNAIRE DR APT 206",
"city": "CICERO",
"state": "NY",
"postal_code": "130393517",
"telephone_number": "315-345-1262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 W 6TH ST",
"city": "OSWEGO",
"state": "NY",
"postal_code": "131262507",
"telephone_number": "315-345-1262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JEREMY",
"name_prefix": "Dr.",
"credential": "PT, DPT, CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-09-23",
"last_updated": "2024-09-23",
"certification_date": "2024-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "NY",
"license": "052956",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oswego, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.