Individual provider Active NPI

Julner Quettant Jr., PT, DPT,MS

  • Physical Therapist
  • Freeport, NY
National Provider Identifier
1447775838
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
025774 Issued in NY
Practice address
63 St Marks Ave
Freeport, NY 11520
Phone
(516) 880-5165
NPI assigned
Aug 7, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 025774 NY Primary

Addresses

Primary practice location

63 St Marks Ave
Freeport, NY 11520

Mailing address

63 Saint Marks Ave
Freeport, NY 11520-5407
Phone (516) 880-5165

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201006000268 NY Practitioner - Physical Therapist in Private Practice 4688093909 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Superior Clinical Care PLLC 10 clinicians

Practice addresses (Care Compare)

178 Morrison Ave
Staten Island, NY 10310-2835
Phone (718) 916-8998

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
025774NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Priority One Therapy PT OT SLP PLLC Single Specialty CurrentSince Apr 15, 2021 Accepting new patients
Essential OT, PT, SLP & Psychology Services, PLLC Single Specialty CurrentSince Sep 1, 2020 Accepting new patients
Superior Clinical Care PLLC Single Specialty CurrentSince Mar 23, 2023 Accepting new patients
Essential Therapy Services of NJ Single Specialty PastSince Aug 1, 2021 Accepting new patients

Locations

99 W Hawthorne Ave
Ste 210
Valley Stream, NY 11580
Phone (718) 305-1190

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": "1502064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1447775838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 SAINT MARKS AVE",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115205407",
            "telephone_number": "516-880-5165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 ST MARKS AVE",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "11520",
            "telephone_number": "516-880-5165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUETTANT",
        "first_name": "JULNER",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PT, DPT,MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-07",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "025774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freeport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.