Emilio Marquez Lasam, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

045272-01 Issued in NY

Practice address

3310 Queens Blvd Ste 301
Long Island City, NY 11101-2302

Phone

(800) 905-0513

Fax

(347) 536-3955

NPI assigned

Dec 30, 2019

Sex

Male

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1577664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577664000000",
    "number": "1306485933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 34TH AVE FL 2",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111062641",
            "telephone_number": "800-905-0513",
            "fax_number": "347-536-3955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3310 QUEENS BLVD STE 301",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111012302",
            "telephone_number": "800-905-0513",
            "fax_number": "347-536-3955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASAM",
        "first_name": "EMILIO",
        "middle_name": "MARQUEZ",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-30",
        "last_updated": "2019-12-30",
        "certification_date": "2019-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "045272-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Long Island City, NY
• Providers in Long Island City, 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 Dec 30, 2019; 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.