Jeremy C Vandevender, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

021302-1 Issued in NY

Practice address

4434 Amboy Rd
Staten Island, NY 10312-3866

Phone

(718) 227-7015

Fax

(718) 227-6411

NPI assigned

May 31, 2006

Last updated

Nov 10, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC

  • Physical Medicine & Rehabilitation Physician
  • New York, NY
  • NPI 1215637699
  NPD (past)
• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path

  dba Axes Physical Therapy

  • Physical Therapist
  • Clinton, IL
  • NPI 1376917187
  NPD (past)

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257811200000",
    "number": "1487691416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4175 VETERANS MEMORIAL HWY",
            "address_2": "SUITE 202",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797639",
            "telephone_number": "631-580-5200",
            "fax_number": "631-580-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4434 AMBOY RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103123866",
            "telephone_number": "718-227-7015",
            "fax_number": "718-227-6411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEVENDER",
        "first_name": "JEREMY",
        "middle_name": "C",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2009-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "021302-1",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00972700",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02584283",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melinda Vancleaf, MSED
• David L Vancott, D.D.S.
• Patricia Vander Neut, MS. CCC-SLP
• Ebenezer Vander Pallen, RN
• Sydney Nicole Vanderhoof
• Douglas Vandyke
• Danny Vanel, CRNA
• Uday Sankar Akash Vankayala, MBBS
• Taylor Vankouwenberg, OTR/L
• Jessica J Vannata, LMSW

• Physical Therapist in Staten Island, NY
• Providers in Staten Island, 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 Nov 10, 2009; 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.