Fresh Pond Physical Therapy Astoria, P.C.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

015401-1 Issued in NY

Legal business name

FRESH POND PHYSICAL THERAPY ASTORIA, P.C.

Practice address

4618 Broadway
Astoria, NY 11103-1628

Phone

(718) 274-4200

Fax

(718) 559-6784

NPI assigned

Apr 9, 2012

Organization subpart

No

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

Authorized official

Name

Liza Tan, DPT, PTNPI 1982628764

Title

Ceo

Phone

(718) 456-2543

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Liza Tan, PT, DPT, MA

  • Physical Therapist
  • Ridgewood, NY
  • NPI 1982628764
  Medicare reassignment Care Compare group NPD Authorized official
• Noreen Lagman, PT

  • Physical Therapist
  • Medford, NY
  • NPI 1275667339
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1333929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463702400000",
    "number": "1477819084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6805 FRESH POND RD",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113855200",
            "telephone_number": "718-456-2545",
            "fax_number": "718-559-6784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4618 BROADWAY",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111031628",
            "telephone_number": "718-274-4200",
            "fax_number": "718-559-6784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH POND PHYSICAL THERAPY ASTORIA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-09",
        "last_updated": "2016-05-20",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "LIZA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-456-2543",
        "authorized_official_credential": "DPT, PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "015401-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yanick Francois
• Andriana Frazis
• Andrew Freeman, AGACNP
• Jordan Freeman, MS BCBA
• Francis David French
• Matthew Frey, LCSW
• Patrick Frey
• Michael Fricchione, D.D.S.
• Remy Friedman, MD
• Jeanne Windle Friedrichs, OTR/L

• Physical Therapist in Astoria, NY
• Providers in Astoria, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; 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.