Provident Health Partners Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PROVIDENT HEALTH PARTNERS INC.

Practice address

1529 N Ocean Ave Ste a
Medford, NY 11763-3587

Phone

(631) 266-4501

Fax

(631) 266-4502

NPI assigned

Jun 8, 2020

Last updated

Jun 8, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Desousa

Title

Administrator

Phone

(631) 266-4501

Specialties & licenses 1

Addresses

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Steven C Desousa, PT

  • Physical Therapist
  • East Northport, NY
  • NPI 1457321911
  NPD (past)
• Mark Guzman, OTR/L

  • Occupational Therapist
  • Great Neck, NY
  • NPI 1003265620
  NPD (past)
• Jennifer E Lackowitz, PT

  • Physical Therapist
  • Patchogue, NY
  • NPI 1881730497
  NPD (past)

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591574400000",
    "number": "1275157000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "554 LARKFIELD RD STE 207",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117314205",
            "telephone_number": "631-266-4501",
            "fax_number": "631-266-4502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1529 N OCEAN AVE STE A",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117633587",
            "telephone_number": "631-266-4501",
            "fax_number": "631-266-4502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT HEALTH PARTNERS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-08",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A",
        "authorized_official_last_name": "DESOUSA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "631-266-4501"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristan Probeck, RN, MS, ANP
• Professional Occupational & Physical Therapy, PLLC
• Professional Orthopedic and Sports Physical Therapy, P.C.
• Professional Rehab P.T., P.C.
• Progressive Rehab Management Corporation
• Casandra J Prygocki, CRNA
• Regina Przywara, LCSW
• Quantix Labs
• Raio Dental, PC
• Dean F Raio, DDS

• Clinic/Center in Medford, NY
• Providers in Medford, NY by specialty
• Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.