Individual provider Active NPI

Malik Campbell

  • Physical Therapist
  • Fleetwood, NY
National Provider Identifier
1346015708
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
051191 Issued in NY
Practice address
559 Gramatan Ave Ste 203-205
Fleetwood, NY 10552-2155
Phone
(914) 371-1990
NPI assigned
Nov 16, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 051191 NY Primary

Addresses

Primary practice location

559 Gramatan Ave Ste 203-205
Fleetwood, NY 10552-2155

Mailing address

576 Broadhollow Rd
Melville, NY 11747-5002
Phone (631) 359-5859

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231229000601 NY Practitioner - Physical Therapist in Private Practice 2567812787 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 Petersville Rd
New Rochelle, NY 10801-4465
Phone (914) 636-5595

44 Saint Marks PL
New York, NY 10003-8118
Phone (212) 529-5966

559 Gramatan Ave
Suite 203
Mount Vernon, NY 10552-2156
Phone (914) 371-1990

Merit-based Incentive Payment System (MIPS)

Final score
78.88 of 100Reported as individual
Quality
75.15
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
051191NYMDOncology Pharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic CurrentSince Mar 1, 2024 Accepting new patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic Physical Therapist CurrentSince Mar 1, 2024 Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Dec 4, 2023 Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Dec 4, 2023 Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist Current Accepting new patients
Professional Orthopedic and Sports Physical Therapy Physical Therapist PastSince Nov 19, 2023 Accepting new patients
Professional Orthopedic and Sports Physical Therapy PC Physical Therapist PastSince Nov 19, 2023 Accepting new patients

Locations

123 Grove Ave
Cedarhurst, NY 11516
Phone (516) 374-4248

576 Broadhollow Rd
Melville, NY 11747

3 Huntington Quadrangle
Ste 103N
Melville, NY 11747
Phone (516) 474-2816

559 Gramatan Ave
Ste 203
Mount Vernon, NY 10552
Phone (914) 371-1990

9525 Queens Blvd
Ste 3D
Rego Park, NY 11374
Phone (718) 925-6212

2142 Utopia Pkwy
Whitestone, NY 11357
Phone (718) 767-0610

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1700092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1346015708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 BROADHOLLOW RD",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117475002",
            "telephone_number": "631-359-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 GRAMATAN AVE STE 203-205",
            "city": "FLEETWOOD",
            "state": "NY",
            "postal_code": "105522155",
            "telephone_number": "914-371-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "MALIK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-16",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "051191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fleetwood, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.