Individual provider Active NPI

Mary Kathleen Sabile Samarista, PT

  • Physical Therapist
  • Bronx, NY
National Provider Identifier
1295374320
Registry record updated Jan 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
040070 Issued in NY
Practice address
1072 Havemeyer Ave
Bronx, NY 10462-5310
Phone
(718) 863-6200
NPI assigned
Jan 6, 2020
Last updated
Jan 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2020

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 040070 NY Primary

Addresses

Primary practice location

1072 Havemeyer Ave
Bronx, NY 10462-5310

Mailing address

1150 Pelham Pkwy S Apt 6C
Bronx, NY 10461-1032
Phone (917) 326-0103

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201023000212 NY Practitioner - Physical Therapist in Private Practice 8224458658 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
At Your Doorstep OT PLLC Physical Therapist CurrentSince Oct 11, 2024 Accepting new patients
Anchor Health Homecare Services Inc Physical Therapist CurrentSince Aug 5, 2022 Accepting new patients
Yk Physical Therapy PLLC Physical Therapist CurrentSince Mar 16, 2022 Accepting new patients
Outreach Physical and Occupational Therapy & Speech Rehabilitation, PLLC Physical Therapist CurrentSince Aug 17, 2020 Accepting new patients
Tres Physical Therapy PLLC Physical Therapist CurrentSince Jan 1, 2024 Accepting new patients

Locations

46 Cook St
Brooklyn, NY 11206
Phone (718) 701-7300

958 Nostrand Ave
Brooklyn, NY 11225
Phone (347) 423-9031

3 Grace Ave
Ste 119
Great Neck, NY 11021
Phone (212) 842-0080

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1578268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578268800000",
    "number": "1295374320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 PELHAM PKWY S APT 6C",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611032",
            "telephone_number": "917-326-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1072 HAVEMEYER AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104625310",
            "telephone_number": "718-863-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMARISTA",
        "first_name": "MARY KATHLEEN",
        "middle_name": "SABILE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-06",
        "last_updated": "2020-01-06",
        "certification_date": "2020-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "040070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; 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.