Individual provider Active NPI

Fahad Nawaz, PTA

  • Physical Therapy Assistant
  • Astoria, NY
National Provider Identifier
1457074932
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
011206 Issued in NY
Practice address
2124 30TH Ave Ste C1
Astoria, NY 11102-3491
Phone
(718) 545-0999
NPI assigned
Sep 20, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 011206 NY Primary

Addresses

Primary practice location

2124 30TH Ave Ste C1
Astoria, NY 11102-3491

Mailing address

6419C 186TH LN Apt 1C
Fresh Meadows, NY 11365-3622
Phone (212) 518-4319

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

LicenseStateTypeSpecialty
011206NYMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Crescent Physical Therapy P.C. CurrentSince Sep 25, 2022 Accepting new patients

Locations

2124 30th Ave
Ste C1
Astoria, NY 11102
Phone (718) 545-0999

Organizations & group practices 1

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": "1663632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1457074932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6419C 186TH LN APT 1C",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113653622",
            "telephone_number": "212-518-4319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 30TH AVE STE C1",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111023491",
            "telephone_number": "718-545-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAWAZ",
        "first_name": "FAHAD",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-20",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "011206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.