NPIMap

Organization Active NPI

Mamaroneck Physical Therapy PC

Doing business as Physical Therapy Associates of Queens

  • Physical Therapist
  • Elmhurst, NY
National Provider Identifier
1306927330
Registry record updated Jun 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
24014 Issued in NY
Legal business name
MAMARONECK PHYSICAL THERAPY PC
Doing business as
Physical Therapy Associates of Queens
Practice address
8202 Grand Ave
Suite 1a
Elmhurst, NY 11373-4133
Phone
(718) 606-2544
Fax
(718) 606-1077
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2013

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

Authorized official

Name
Christopher Bautista, MBA
Title
Administrator
Phone
(718) 606-2544

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 24014 NY Primary

Addresses

Primary practice location

8202 Grand Ave
Suite 1a
Elmhurst, NY 11373-4133

Mailing address

8202 Grand Ave
Suite 1a
Elmhurst, NY 11373-4133
Phone (718) 606-2544

Other identifiers 1

IdentifierTypeStateIssuer
0214844MedicaidNY

Other names 1

  • Physical Therapy Associates of Queens Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371686400000",
    "number": "1306927330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8202 GRAND AVE",
            "address_2": "SUITE 1A",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734133",
            "telephone_number": "718-606-2544",
            "fax_number": "718-606-1077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8202 GRAND AVE",
            "address_2": "SUITE 1A",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734133",
            "telephone_number": "718-606-2544",
            "fax_number": "718-606-1077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAMARONECK PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2013-06-20",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "718-606-2544",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "24014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0214844",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physical Therapy Associates of Queens",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elmhurst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; 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.