Individual provider Active NPI

Adrian Clark, DPT

  • Physical Therapist
  • New York, NY
National Provider Identifier
1396587978
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
052426 Issued in NY
Practice address
159 E 74TH St # 3
New York, NY 10021-3235
Phone
(646) 762-4414
NPI assigned
Jun 12, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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 052426 NY Primary

Addresses

Primary practice location

159 E 74TH St # 3
New York, NY 10021-3235

Mailing address

159 E 74TH St # 3
New York, NY 10021-3235
Phone (646) 762-4414

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240620000848 NY Practitioner - Physical Therapist in Private Practice 0042753931 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

159 E 74TH St
Unit 3
New York, NY 10021-3235
Phone (646) 762-4414

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC CurrentSince Jun 10, 2024 Accepting new patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path Physical Therapist CurrentSince Jun 10, 2024 Accepting new patients

Locations

490 Driggs Ave
Brooklyn, NY 11211
Phone (347) 329-4572

973 Fulton St
Brooklyn, NY 11238
Phone (718) 230-1180

25 Flatbush Ave
Ste 3
Brooklyn, NY 11217
Phone (718) 852-2584

142 Prospect Park W
Brooklyn, NY 11215
Phone (718) 230-1180

1412 Cortelyou Rd
Brooklyn, NY 11226
Phone (347) 699-1011

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

159 E 74th St
Ste 3
New York, NY 10021
Phone (212) 838-8023

159 E 74th St
#3
New York, NY 10021
Phone (646) 762-4414

159 E 74th St
Unit 3
New York, NY 10021
Phone (466) 762-4414

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": "1718150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1396587978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 E 74TH ST # 3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100213235",
            "telephone_number": "646-762-4414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 E 74TH ST # 3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100213235",
            "telephone_number": "646-762-4414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ADRIAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-12",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "052426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.