Active NPI
Eugene Steven Crisostomo, PHYSICAL THERAPIST
- Physical Therapist
- Bronx, NY
National Provider Identifier
1417277716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 024878
- Practice address
- 245 East 149TH St.
Bronx, NY 10451 - Phone
- (718) 665-7565
- NPI assigned
- Jun 9, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 024878 | NY | Primary |
Addresses
Primary practice location
245 East 149TH St.
Bronx, NY 10451
Mailing address
66 Floradan Rd
Putnam Valley, NY 10579
Phone (917) 774-0217
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 024878 | Other | NY | PT LICENSE |
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 |
|---|---|---|---|
| 024878 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276041600000",
"number": "1417277716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66 FLORADAN RD",
"city": "PUTNAM VALLEY",
"state": "NY",
"postal_code": "10579",
"telephone_number": "917-774-0217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 EAST 149TH ST.",
"city": "BRONX",
"state": "NY",
"postal_code": "10451",
"telephone_number": "718-665-7565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRISOSTOMO",
"first_name": "EUGENE",
"middle_name": "STEVEN",
"name_prefix": "Mr.",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-06-09",
"last_updated": "2010-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "024878",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE",
"identifier": "024878",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.