Individual provider Active NPI

Jeanine Perrelli

  • Physical Therapist
  • Hauppauge, NY
National Provider Identifier
1255169603
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
050695 Issued in NY
Practice address
360 Motor Pkwy
Hauppauge, NY 11788-5182
Phone
(631) 232-5350
NPI assigned
Jul 25, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 050695 NY Primary

Addresses

Primary practice location

360 Motor Pkwy
Hauppauge, NY 11788-5182

Mailing address

43 Marquette Dr
Smithtown, NY 11787-2022

Other practice location 1

128 Old Town Rd
East Setauket, NY 11733-2064
Phone (631) 246-6072

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240828003713 NY Practitioner - Physical Therapist in Private Practice 5294274700 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

128 Old Town Rd
East Setauket, NY 11733-2064
Phone (631) 246-6072

550 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

9785 Queens Blvd
Rego Park, NY 11374-3319
Phone (718) 261-9100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
050695NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Physical Occupational Speech Massage Therapy & Acupuncture PLLC Physical Therapist CurrentSince Aug 1, 2024 Accepting new patients
Body in Balance Physical Therapy Physical Therapist PastSince Apr 22, 2021 Accepting new patients

Locations

12 Technology Dr
Unit 2
East Setauket, NY 11733
Phone (631) 232-5350

800 E Gate Blvd
Garden City, NY 11530

50 Glen Cove Rd
Greenvale, NY 11548
Phone (516) 200-3545

360 Motor Pkwy
Hauppauge, NY 11788
Phone (631) 232-5350

1150 Portion Rd
Ste 3
Holtsville, NY 11742
Phone (631) 304-0781

11701 84th Ave
Richmond Hill, NY 11418
Phone (718) 441-0300

238 Main St
Setauket, NY 11733
Phone (631) 246-6072

128 Old Town Rd
Setauket, NY 11733
Phone (631) 246-6072

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": "1721865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1255169603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 MARQUETTE DR",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 MOTOR PKWY",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117885182",
            "telephone_number": "631-232-5350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "128 Old Town Rd",
            "address_purpose": "LOCATION",
            "city": "East Setauket",
            "state": "NY",
            "postal_code": "117332064",
            "country_code": "US",
            "telephone_number": "631-246-6072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERRELLI",
        "first_name": "JEANINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-25",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "050695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hauppauge, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.