Individual provider Active NPI

Yaniv Raich, DPT

  • Physical Therapist
  • Mineola, NY
National Provider Identifier
1356625305
Registry record updated Jun 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
031561-1 Issued in NY
Practice address
193 Jericho Tpke
Mineola, NY 11501
Phone
(516) 747-2323
Fax
(516) 747-2305
NPI assigned
Oct 7, 2011
Last updated
Jun 7, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 7, 2018

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 031561-1 NY Primary

Addresses

Primary practice location

193 Jericho Tpke
Mineola, NY 11501

Mailing address

193 Jericho Tpke
Mineola, NY 11501-1702
Phone (516) 747-2323

Other practice location 1

475 Northern Blvd Ste 11
Great Neck, NY 11021-4802
Phone (516) 466-7720

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111101000735 NY Practitioner - Physical Therapist in Private Practice 9537332804 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

193 Jericho Tpke
Mineola, NY 11501-1702
Phone (516) 747-2323

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
031561-1NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Innovative Physical Therapy of Long Island P.C. Physical Therapist CurrentSince Jul 9, 2018 Accepting new patients

Locations

193 Jericho Tpke
Mineola, NY 11501
Phone (516) 747-2323

Organizations & group practices 1

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": "1317945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528329600000",
    "number": "1356625305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "193 JERICHO TPKE",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115011702",
            "telephone_number": "516-747-2323",
            "fax_number": "516-747-2305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "193 JERICHO TPKE",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "11501",
            "telephone_number": "516-747-2323",
            "fax_number": "516-747-2305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Northern Blvd Ste 11",
            "address_purpose": "LOCATION",
            "city": "Great Neck",
            "state": "NY",
            "postal_code": "110214802",
            "country_code": "US",
            "telephone_number": "516-466-7720",
            "fax_number": "516-466-7723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAICH",
        "first_name": "YANIV",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-07",
        "last_updated": "2018-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "031561-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; 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.