NPIMap

Organization Active NPI

Dynamic Physical Therapy Services PC

  • Physical Therapist
  • Flushing, NY
National Provider Identifier
1497717375
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
NY PT LIC NO: 014635 Issued in NY
Legal business name
DYNAMIC PHYSICAL THERAPY SERVICES PC
Practice address
4343 Kissena Blvd
Suite 110
Flushing, NY 11355-2950
Phone
(718) 661-1710
Fax
(718) 886-6414
NPI assigned
Apr 5, 2006
Last updated
Oct 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Authorized official

Name
Mr. Nilesh SoniNPI 1124080023
Title
President
Phone
(718) 661-1710

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X NY PT LIC NO: 014635 NY Primary

Addresses

Primary practice location

4343 Kissena Blvd
Suite 110
Flushing, NY 11355-2950

Mailing address

4343 Kissena Blvd
Suite 110
Flushing, NY 11355-2950
Phone (718) 661-1710

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040309001195 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2961390026 Receives reassigned benefits from 15 practitioners
Practice locations: Flushing, NY; South Richmond Hill, NY; Ozone Park, NY; Massapequa, NY; Glen Oaks, NY; Franklin Square, NY; Hicksville, NY

National Provider Directory

National Provider Directory

Locations

653 Myrtle Dr
Covington, LA 70433
Phone (985) 893-4700

7520 Westbank Expy
Ste D
Marrero, LA 70072
Phone (504) 371-4226

1340 Westbank Expy
Westwego, LA 70094
Phone (504) 371-4226

2515 Steinway St
Astoria, NY 11103
Phone (347) 832-0035

4343 Kissena Blvd
Ste 110
Flushing, NY 11355
Phone (718) 463-1515

924 N Broadway
Massapequa, NY 11758
Phone (516) 520-5507

Practitioners & affiliated clinicians

Practitioners 72

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.

View all 72

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1497717375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4343 KISSENA BLVD",
            "address_2": "SUITE 110",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113552950",
            "telephone_number": "718-661-1710",
            "fax_number": "718-886-6414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 KISSENA BLVD",
            "address_2": "SUITE 110",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113552950",
            "telephone_number": "718-661-1710",
            "fax_number": "718-886-6414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PHYSICAL THERAPY SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "SONI",
        "authorized_official_first_name": "NILESH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-661-1710",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "NY PT LIC NO: 014635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.