Individual provider Active NPI

Diana Rose Tjaden, PHYSICAL THERAPIST

  • Physical Therapist
  • Garden City, NY
National Provider Identifier
1366524829
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
025535-1 Issued in NY
Practice address
310 Old Country Rd Ste 104
Garden City, NY 11530-1763
Phone
(516) 741-7000
NPI assigned
Oct 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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 025535-1 NY Primary

Addresses

Primary practice location

310 Old Country Rd Ste 104
Garden City, NY 11530-1763

Mailing address

1377 Motor Pkwy Ste 307
Islandia, NY 11749-5258
Phone (631) 580-5200

Other practice location 1

3961 Long Beach Road
Island Park, NY 11558
Phone (516) 897-9700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060130000203 NY Practitioner - Physical Therapist in Private Practice 3971517962 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

225 Merrick Rd
Lynbrook, NY 11563-2621
Phone (516) 559-8734

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
025535-1NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path Physical Therapist CurrentSince Nov 16, 2020 Accepting new patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC CurrentSince Nov 16, 2020 Accepting new patients

Locations

310 Old Country Rd
Ste 104
Garden City, NY 11530
Phone (516) 741-7000

550 Mamaroneck Ave
Ste 104
Harrison, NY 10528
Phone (914) 777-3737

3961 Long Beach Rd
Island Park, NY 11558
Phone (516) 599-8734

225 Merrick Rd
Lynbrook, NY 11563
Phone (516) 599-8734

412 Market St
Nanuet, NY 10954
Phone (347) 741-3619

57 Old Shore Rd
Port Washington, NY 11050
Phone (516) 464-7959

1377 Motor Pkwy
Ste 307
Ronkonkoma, NY 11749

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1366524829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "631-580-5200",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 OLD COUNTRY RD STE 104",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115301763",
            "telephone_number": "516-741-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3961 Long Beach Road",
            "address_purpose": "LOCATION",
            "city": "Island Park",
            "state": "NY",
            "postal_code": "11558",
            "country_code": "US",
            "telephone_number": "516-897-9700",
            "fax_number": "516-897-0529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TJADEN",
        "first_name": "DIANA",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "025535-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; 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.