Individual provider Active NPI

Neil Obeso, DPT

  • Physical Therapist
  • Stony Brook, NY
National Provider Identifier
1437754942
Registry record updated Dec 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
046604-01 Issued in NY
Practice address
97 Main St Ste H
Stony Brook, NY 11790-1900
Phone
(631) 751-6680
NPI assigned
Dec 2, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 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 046604-01 NY Primary

Addresses

Primary practice location

97 Main St Ste H
Stony Brook, NY 11790-1900

Mailing address

190 Sound Beach Blvd
Sound Beach, NY 11789-1644
Phone (631) 413-1757

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210210001603 NY Practitioner - Physical Therapist in Private Practice 4880009596 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

9525 Queens Blvd
Suite 3D
Rego Park, NY 11374-4510
Phone (718) 925-6212

Merit-based Incentive Payment System (MIPS)

Final score
77.16 of 100Reported as group
Quality
70
Improvement activities
40
Cost
78.87

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046604-01NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Latitude Physical Therapy Physical Therapist CurrentSince Feb 1, 2024 Accepting new patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic CurrentSince Nov 1, 2022 Accepting new patients
Kah Premium Physical Therapy P.C. Physical Therapist CurrentSince Jan 4, 2021 Accepting new patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic Physical Therapist CurrentSince Nov 1, 2022 Accepting new patients

Locations

50 E 42nd St
Rm 702
New York, NY 10017
Phone (212) 470-2735

9525 Queens Blvd
Ste 3D
Rego Park, NY 11374
Phone (718) 925-6212

34 Bay St
#205206
Sag Harbor, NY 11963
Phone (631) 919-5189

97 Main St
Ste H
Stony Brook, NY 11790
Phone (631) 751-6680

Organizations & group practices 4

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": "1606867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606867200000",
    "number": "1437754942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 SOUND BEACH BLVD",
            "city": "SOUND BEACH",
            "state": "NY",
            "postal_code": "117891644",
            "telephone_number": "631-413-1757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 MAIN ST STE H",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117901900",
            "telephone_number": "631-751-6680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBESO",
        "first_name": "NEIL",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-02",
        "last_updated": "2020-12-02",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "046604-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.