NPIMap

Organization Active NPI

GNLC Physical Therapy PLLC

  • Physical Therapist
  • Lake Ronkonkoma, NY
National Provider Identifier
1376930974
Registry record updated Jun 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
22606 Issued in NY
Legal business name
GNLC PHYSICAL THERAPY PLLC
Practice address
500 Portion Rd
Suite5
Lake Ronkonkoma, NY 11779-4587
Phone
(631) 588-2100
Fax
(631) 588-2299
NPI assigned
Apr 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2015

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

Authorized official

Name
Ms. Jill Szuflada
Title
Office Manager
Phone
(631) 588-2100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 22606 NY Primary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 033193 NY

Addresses

Primary practice location

500 Portion Rd
Suite5
Lake Ronkonkoma, NY 11779-4587

Mailing address

500 Portion Rd
Suite5
Lake Ronkonkoma, NY 11779-4587
Phone (631) 588-2100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150916001412 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5890002307 Receives reassigned benefits from 2 practitioners
Practice locations: Lake Ronkonkoma, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435536000000",
    "number": "1376930974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PORTION RD",
            "address_2": "SUITE5",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117794587",
            "telephone_number": "631-588-2100",
            "fax_number": "631-588-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PORTION RD",
            "address_2": "SUITE5",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117794587",
            "telephone_number": "631-588-2100",
            "fax_number": "631-588-2299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GNLC PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-21",
        "last_updated": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "SZUFLADA",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "631-588-2100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "22606",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "033193",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Ronkonkoma, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.