Individual provider Active NPI

Kornelia Mierzejewska

  • Physical Therapy Assistant
  • Woodridge, NY
National Provider Identifier
1316618317
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
010690 Issued in NY
Practice address
53 Meadowlark LN
Woodridge, NY 12789-5813
Phone
(347) 515-5551
NPI assigned
Sep 21, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 010690 NY Primary

Addresses

Primary practice location

53 Meadowlark LN
Woodridge, NY 12789-5813

Mailing address

53 Meadowlark LN
Woodridge, NY 12789-5813
Phone (347) 515-5551

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL laptop Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
010690NYMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1316618317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 MEADOWLARK LN",
            "city": "WOODRIDGE",
            "state": "NY",
            "postal_code": "127895813",
            "telephone_number": "347-515-5551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 MEADOWLARK LN",
            "city": "WOODRIDGE",
            "state": "NY",
            "postal_code": "127895813",
            "telephone_number": "347-515-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIERZEJEWSKA",
        "first_name": "KORNELIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-21",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "010690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "laptop",
            "affiliation": "N",
            "endpointDescription": "personal device",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "925 S Semoran Blvd Ste 110A",
            "city": "Winter Park",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327925313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Woodridge, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; 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.