Individual provider Active NPI

Melba Ocampo Suarez-Iavarone, PT

  • Physical Therapist
  • New York, NY
National Provider Identifier
1356553796
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
021408-1 Issued in NY
Practice address
24 5TH Ave Apt 1112
New York, NY 10011-8820
Phone
(917) 685-9334
Fax
(212) 228-2052
NPI assigned
May 6, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 021408-1 NY Primary

Addresses

Primary practice location

24 5TH Ave Apt 1112
New York, NY 10011-8820

Mailing address

3935 51St St Apt 4F
Woodside, NY 11377-3168
Phone (718) 440-7709

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050810000113 NY Practitioner - Physical Therapist in Private Practice 0345279394 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
021408-1NYMDPhysical Therapist
021408NYMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Outreach Physical and Occupational Therapy & Speech Rehabilitation, PLLC Physical Therapist CurrentSince Jun 18, 2019 Accepting new patients
Outreach Physical Therapy PC Physical Therapist Past Accepting new patients

Locations

3 Grace Ave
Ste 119
Great Neck, NY 11021
Phone (212) 842-0080

147 W 35th St
Ste 407
New York, NY 10001
Phone (212) 842-0080

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1178409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356553796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3935 51ST ST APT 4F",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113773168",
            "telephone_number": "718-440-7709",
            "fax_number": "718-606-9733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 5TH AVE APT 1112",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100118820",
            "telephone_number": "917-685-9334",
            "fax_number": "212-228-2052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUAREZ-IAVARONE",
        "first_name": "MELBA",
        "middle_name": "OCAMPO",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "021408-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.