Active NPI
Gerhard Conrad Endal, OT
- Occupational Therapist
- South Glens Falls, NY
National Provider Identifier
1407030133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 12983
- Practice address
- 90 Feeder Dam Rd
South Glens Falls, NY 12803-5419 - Phone
- (518) 744-9829
- Fax
- (518) 792-8075
- NPI assigned
- Dec 17, 2007
- Last updated
- Dec 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 12983 | FL | Primary |
| Occupational Therapist | 225X00000X | 002200-1 | NY |
Addresses
Primary practice location
90 Feeder Dam Rd
South Glens Falls, NY 12803-5419
Mailing address
90 Feeder Dam Rd
South Glens Falls, NY 12803-5419
Phone (518) 744-9829
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12983 | FL | MD | Clinical Psychologist |
| 002200-1 | NY | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197849600000",
"number": "1407030133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 FEEDER DAM RD",
"city": "SOUTH GLENS FALLS",
"state": "NY",
"postal_code": "128035419",
"telephone_number": "518-744-9829",
"fax_number": "518-792-8075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 FEEDER DAM RD",
"city": "SOUTH GLENS FALLS",
"state": "NY",
"postal_code": "128035419",
"telephone_number": "518-744-9829",
"fax_number": "518-792-8075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENDAL",
"first_name": "GERHARD",
"middle_name": "CONRAD",
"name_prefix": "Mr.",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-17",
"last_updated": "2007-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "12983",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "002200-1",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Glens Falls, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.