Mark Boodram, PT, DPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

Practice address

138 5TH Ave FL 2
New York, NY 10011-4367

Phone

(646) 490-4002

NPI assigned

Sep 27, 2024

Sex

Male

Sole proprietor

Yes

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.

• Bespoke Treatments Physical Therapy PC

  • Physical Therapy Clinic/Center
  • New York, NY
  • NPI 1336756758
  Medicare reassignment Care Compare group NY

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Group practices

Bespoke Treatments Physical Therapy PC 23 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in NY

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 27, 2024.

{
    "created_epoch": "1727395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1255159463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 5TH AVE FL 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100114367",
            "telephone_number": "646-490-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 5TH AVE FL 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100114367",
            "telephone_number": "646-490-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOODRAM",
        "first_name": "MARK",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-27",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frank Bonura, LMSW
• Jessica Anne Bonura, NP
• Daniela Bonvicini, NP
• Hyunji Boo, DPM
• Shenera P Boodie
• Pamela Boodram, MD
• Allison Grace Booher, MD
• Jessica Booher
• Brandon Michael Book, HAD
• William Book, M.D.

• All providers in New York, NY
• Orthopedic Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.