Active NPI
Siobhan Catherine Stack, DPT
- Orthopedic Physical Therapist
- Bay Shore, NY
National Provider Identifier
1366145054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 049448
- Practice address
- 62 W Main St
Bay Shore, NY 11706-8314 - Phone
- (631) 665-4560
- NPI assigned
- Mar 23, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 049448 | NY | Primary |
Addresses
Primary practice location
62 W Main St
Bay Shore, NY 11706-8314
Mailing address
62 W Main St
Bay Shore, NY 11706-8314
Phone (516) 830-1818
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 |
|---|---|---|---|
| 049448 | NY | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Panetta Physical Therapy, PC | Orthopedic | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679529600000",
"number": "1366145054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62 W MAIN ST",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117068314",
"telephone_number": "516-830-1818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62 W MAIN ST",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117068314",
"telephone_number": "631-665-4560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACK",
"first_name": "SIOBHAN",
"middle_name": "CATHERINE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-23",
"last_updated": "2023-03-23",
"certification_date": "2023-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "NY",
"license": "049448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay Shore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.