Active NPI
Jose Allan M De Vera, PT
- Physical Therapist
- Brooklyn, NY
National Provider Identifier
1346574274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 013175
- Practice address
- 1630 E 15TH St
Brooklyn, NY 11229-1147 - Phone
- (718) 787-3214
- NPI assigned
- Sep 24, 2009
- Sex
- Male
- 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 | 013175 | NY | Primary |
Addresses
Primary practice location
1630 E 15TH St
Brooklyn, NY 11229-1147
Mailing address
1630 E 15TH St
Brooklyn, NY 11229-1147
Phone (718) 787-3214
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
| License | State | Type | Specialty |
|---|---|---|---|
| 013175 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253750400000",
"number": "1346574274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1630 E 15TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112291147",
"telephone_number": "718-787-3214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1630 E 15TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112291147",
"telephone_number": "718-787-3214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE VERA",
"first_name": "JOSE ALLAN",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-09-24",
"last_updated": "2009-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "013175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.