Active NPI
Ryan Michael Roach, OTR
- Occupational Therapist
- Brooklyn, NY
National Provider Identifier
1366014748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 026951
- Practice address
- 240 Howard Ave Apt 302
Brooklyn, NY 11233-2320 - Phone
- (508) 241-7000
- NPI assigned
- Jul 14, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 09340 | MD | |
| Occupational Therapist | 225X00000X | OT200001224 | DC | |
| Occupational Therapist | 225X00000X | |||
| Occupational Therapist | 225X00000X | 026951 | NY | Primary |
Addresses
Primary practice location
240 Howard Ave Apt 302
Brooklyn, NY 11233-2320
Mailing address
240 Howard Ave Apt 302
Brooklyn, NY 11233-2320
Phone (508) 241-7000
Other practice location 1
6929 Matthew Pl
Springfield, VA 22151-3607
Phone (703) 813-1800
Other practice location 2
6251 Old Dominion Dr
Mc Lean, VA 22101-4827
Phone (703) 536-4344
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 |
|---|---|---|---|
| 09340 | MD | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661731200000",
"number": "1366014748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 HOWARD AVE APT 302",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112332320",
"telephone_number": "508-241-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 HOWARD AVE APT 302",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112332320",
"telephone_number": "508-241-7000"
}
],
"practiceLocations": [
{
"address_1": "6929 Matthew Pl",
"address_purpose": "LOCATION",
"city": "Springfield",
"state": "VA",
"postal_code": "221513607",
"country_code": "US",
"telephone_number": "703-813-1800",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6251 Old Dominion Dr",
"address_purpose": "LOCATION",
"city": "Mc Lean",
"state": "VA",
"postal_code": "221014827",
"country_code": "US",
"telephone_number": "703-536-4344",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROACH",
"first_name": "RYAN",
"middle_name": "MICHAEL",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-07-14",
"last_updated": "2022-08-29",
"certification_date": "2022-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MD",
"license": "09340",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "DC",
"license": "OT200001224",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "026951",
"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 Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.