Diana Mary Innocent, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

051531 Issued in NY

Practice address

80 Route 6 Unit 701702
Baldwin Place, NY 10505-1026

Phone

(845) 875-0500

NPI assigned

Mar 5, 2024

Last updated

Mar 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC

  dba IvyRehab for Kids

  • Early Intervention Provider Agency
  • Baldwin Place, NY
  • NPI 1528749496
  NPD

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

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1295592202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 HERITAGE DR APT B",
            "city": "NEW CITY",
            "state": "NY",
            "postal_code": "109565348",
            "telephone_number": "845-596-8302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 ROUTE 6 UNIT 701702",
            "city": "BALDWIN PLACE",
            "state": "NY",
            "postal_code": "105051026",
            "telephone_number": "845-875-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INNOCENT",
        "first_name": "DIANA",
        "middle_name": "MARY",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-05",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "051531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Marie Cain, DPT
• Nicole Derobertis, DPT
• Andrea Carmina Eisley, PHARMD
• Jenny Marie Fadda, RD, CDN, CNSC
• Alexis Hannah Goldstein
• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC (IvyRehab for Kids)
• Meagan Kobielski, OTR/L
• Carissa Varbaro Majdanski, MS, PT
• Lee S Marcus, MD FACC
• Gerta Memeti, PHARMD

• Physical Therapist in Baldwin Place, NY
• Providers in Baldwin Place, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; 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.