Active NPI
Kelly Ann Martin
- Physical Therapist
- Garden City, NY
National Provider Identifier
1336729896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 045296-01
- Practice address
- 800 E Gate Blvd
Garden City, NY 11530-2105 - Phone
- (516) 745-8050
- NPI assigned
- Apr 9, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 045296-01 | NY | Primary |
Addresses
Primary practice location
800 E Gate Blvd
Garden City, NY 11530-2105
Mailing address
342 W 15TH St
Deer Park, NY 11729-6306
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 045296 | NY | MD | Pharmacist |
| 045296-01 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617926400000",
"number": "1336729896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "342 W 15TH ST",
"city": "DEER PARK",
"state": "NY",
"postal_code": "117296306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E GATE BLVD",
"city": "GARDEN CITY",
"state": "NY",
"postal_code": "115302105",
"telephone_number": "516-745-8050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KELLY",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-09",
"last_updated": "2021-04-09",
"certification_date": "2021-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "045296-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.