Vannisa Pelage

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

012703-01 Issued in NY

Practice address

475 Northern Blvd
Great Neck, NY 11021-4819

Phone

(917) 968-8497

NPI assigned

Oct 27, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1366106197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1072 ROGERS AVE APT 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112266221",
            "telephone_number": "347-586-1228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 NORTHERN BLVD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214819",
            "telephone_number": "917-968-8497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELAGE",
        "first_name": "VANNISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-27",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "012703-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Occupational Therapy of Ny, PC
• Pediatric Ophthalmology of Greater Ny, PC
• Consuelo Pedro
• Henry Pek, M.D.
• Monika Rosemary Pek, MD
• Nicole Pelan, FNP
• David Pelcovitz, PHD
• Regina M. Pemberton, L.CSW
• Carmine Pena, DDS
• Luz Marina Pena, DPT

• Physical Therapy Assistant in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.