NPIMap

Organization Active NPI

Michael Baranov Physical Therapy PC

  • Physical Therapist
  • Brooklyn, NY
National Provider Identifier
1467496679
Registry record updated Oct 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MICHAEL BARANOV PHYSICAL THERAPY PC
Practice address
4119 18TH Ave
Brooklyn, NY 11218-5709
Phone
(718) 975-3515
Fax
(718) 975-3514
NPI assigned
Jun 16, 2006
Last updated
Oct 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Authorized official

Name
Mr. Michael Baranov, PTNPI 1710934765
Title
Owner
Phone
(718) 975-3515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

4119 18TH Ave
Brooklyn, NY 11218-5709

Mailing address

15611 Aguilar Ave # 1018
Flushing, NY 11367-2732
Phone (718) 975-3515

Other practice location 1

156-11 Aguilar Ave
P1
Flushing, NY 11367-2731
Phone (718) 380-4750

Other identifiers 2

IdentifierTypeStateIssuer
03356723MedicaidNY
A100123733OtherNYMEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050405001216 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0244297620 Receives reassigned benefits from 2 practitioners
Practice locations: Brooklyn, NY; Flushing, NY; Fresh Meadows, NY

National Provider Directory

National Provider Directory

Locations

15611 Aguilar Ave
Ste P1
Flushing, NY 11367
Phone (718) 380-4750

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1467496679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15611 AGUILAR AVE # 1018",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113672732",
            "telephone_number": "718-975-3515",
            "fax_number": "718-975-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4119 18TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112185709",
            "telephone_number": "718-975-3515",
            "fax_number": "718-975-3514"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "156-11 Aguilar Ave",
            "address_2": "P1",
            "address_purpose": "LOCATION",
            "city": "Flushing",
            "state": "NY",
            "postal_code": "113672731",
            "country_code": "US",
            "telephone_number": "718-380-4750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MICHAEL BARANOV PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "BARANOV",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-975-3515",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03356723",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "A100123733",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.