Individual provider Active NPI

Joseph Patrick Taverni, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Great Neck, NY
National Provider Identifier
1245363415
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
201665 Issued in NY
Practice address
1000 Northern Blvd
Suite 360
Great Neck, NY 11021-5312
Phone
(516) 482-7747
Fax
(516) 482-7748
NPI assigned
Mar 14, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 201665 NY Primary

Addresses

Primary practice location

1000 Northern Blvd
Suite 360
Great Neck, NY 11021-5312

Mailing address

1000 Northern Blvd
Suite 360
Great Neck, NY 11021-5312
Phone (516) 482-7747

Other identifiers 1

IdentifierTypeStateIssuer
01990183MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110305000000 NY Practitioner - Physical Medicine and Rehabilitation 2163604638 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
201665NYMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Parkway Pain Care & Rehabilitation P.C. Physical Medicine & Rehabilitation CurrentSince Sep 1, 2021 Accepting new patients
New York University Physical Medicine & Rehabilitation CurrentSince Oct 1, 2016 Accepting new patients
New York University Physical Medicine & Rehabilitation CurrentSince Oct 1, 2016 Accepting new patients

Locations

4303 14th Ave
Brooklyn, NY 11219
Phone (718) 436-7800

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1245363415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 NORTHERN BLVD",
            "address_2": "SUITE 360",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215312",
            "telephone_number": "516-482-7747",
            "fax_number": "516-482-7748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 NORTHERN BLVD",
            "address_2": "SUITE 360",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215312",
            "telephone_number": "516-482-7747",
            "fax_number": "516-482-7748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVERNI",
        "first_name": "JOSEPH",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "201665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01990183",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.