Active NPI
Maria Angelica Matahum Farrell, DPT
- Physical Therapist
- Oswego, NY
National Provider Identifier
1437856192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 041908-01
- Practice address
- 159 W 1St St
Oswego, NY 13126-2260 - Phone
- (315) 342-9575
- Fax
- (315) 216-0933
- NPI assigned
- Feb 13, 2023
- Sex
- Female
- 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 | 041908-01 | NY | Primary |
Addresses
Primary practice location
159 W 1St St
Oswego, NY 13126-2260
Mailing address
33 Sullivan Rd
Lake George, NY 12845-4337
Phone (929) 302-0688
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 041908-01 | Other | NY | OFFICE OF THE PROFESSIONS |
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 |
|---|---|---|---|
| 041908-01 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701129600000",
"number": "1437856192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 SULLIVAN RD",
"city": "LAKE GEORGE",
"state": "NY",
"postal_code": "128454337",
"telephone_number": "929-302-0688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 W 1ST ST",
"city": "OSWEGO",
"state": "NY",
"postal_code": "131262260",
"telephone_number": "315-342-9575",
"fax_number": "315-216-0933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARRELL",
"first_name": "MARIA ANGELICA",
"middle_name": "MATAHUM",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-13",
"last_updated": "2023-11-28",
"certification_date": "2023-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "041908-01",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OFFICE OF THE PROFESSIONS",
"identifier": "041908-01",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oswego, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.