Dexter Bongato

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

036357 Issued in NY

Practice address

6805 Fresh Pond Rd
Ridgewood, NY 11385-5200

Phone

(718) 456-2545

Fax

(718) 559-6784

NPI assigned

Oct 22, 2015

Last updated

Oct 22, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Central Park Physical Medicine and Rehabilitation P.C.

  • Physical Medicine & Rehabilitation Physician
  • Bronx, NY
  • NPI 1396813184
  Medicare reassignment
• Fresh Pond Physical Therapy, P.C

  • Physical Therapy Clinic/Center
  • Ridgewood, NY
  • NPI 1962885491
  Authorized official Same address or phone

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

{
    "created_epoch": "1445472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445472000000",
    "number": "1245602853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6805 FRESH POND RD",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113855200",
            "telephone_number": "718-456-2545",
            "fax_number": "718-559-6784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6805 FRESH POND RD",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113855200",
            "telephone_number": "718-456-2545",
            "fax_number": "718-559-6784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONGATO",
        "first_name": "DEXTER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-10-22",
        "last_updated": "2015-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "036357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rekha Bhandari, MD
• Dennis Block
• Denis Eduardo Blumberg, LCSW, CASAC
• Bonafide Eyewear LLC (Bonafide Eyeware)
• Frank M Bone, DDS
• Jaclyn Bonnici
• Kailip Boonrai, MD
• Anna Kubicz Borowik, MSPT
• Patricia Lynn Bower, LPN
• P Brathwaite, OTR/L

• Physical Therapy Clinic/Center in Ridgewood, NY
• Providers in Ridgewood, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2015; 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.