NPIMap

Organization Active NPI

Elite Performance Physical Therapy PC

  • Physical Therapy Clinic/Center
  • Garden City, NY
National Provider Identifier
1285969188
Registry record updated Aug 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
030387 Issued in NY
Legal business name
ELITE PERFORMANCE PHYSICAL THERAPY PC
Practice address
1325 Franklin Ave
Suite Ll105
Garden City, NY 11530-1666
Phone
(516) 280-8811
Fax
(516) 280-8809
NPI assigned
Oct 9, 2009
Last updated
Aug 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2014

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

Authorized official

Name
Dr. Michael Robert Defeo, DPTNPI 1942464714
Title
President
Phone
(516) 280-8811

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 030387 NY Primary

Addresses

Primary practice location

1325 Franklin Ave
Suite Ll105
Garden City, NY 11530-1666

Mailing address

1325 Franklin Ave
Suite Ll105
Garden City, NY 11530-1666
Phone (516) 280-8811

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091202000300 NY Part B Supplier - Clinic/Group Practice 2567501604 Receives reassigned benefits from 9 practitioners
Practice locations: Garden City, NY

National Provider Directory

National Provider Directory

Locations

1325 Franklin Ave
Ste LL105
Garden City, NY 11530
Phone (516) 280-8811

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1255046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407715200000",
    "number": "1285969188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 FRANKLIN AVE",
            "address_2": "SUITE LL105",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115301666",
            "telephone_number": "516-280-8811",
            "fax_number": "516-280-8809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 FRANKLIN AVE",
            "address_2": "SUITE LL105",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115301666",
            "telephone_number": "516-280-8811",
            "fax_number": "516-280-8809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PERFORMANCE PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-09",
        "last_updated": "2014-08-11",
        "status": "A",
        "authorized_official_last_name": "DEFEO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-280-8811",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "030387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; 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.