Active NPI
Russell Roy Santos Leviste, PT
- Physical Therapist
- Astoria, NY
National Provider Identifier
1508277849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 035003
- Practice address
- 27-51 27TH Street
Astoria, NY 11102 - Phone
- (718) 728-0612
- Fax
- (718) 545-7771
- NPI assigned
- May 8, 2014
- Last updated
- May 8, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 035003 | NY | Primary |
Addresses
Primary practice location
27-51 27TH Street
Astoria, NY 11102
Mailing address
27-51 27TH Street
Astoria, NY 11102
Phone (718) 728-0612
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 035003 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapeutic Physical Therapy PC | Physical Therapist | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Westbury, NY
- NPI 1093853657
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399507200000",
"number": "1508277849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27-51 27TH STREET",
"city": "ASTORIA",
"state": "NY",
"postal_code": "11102",
"telephone_number": "718-728-0612",
"fax_number": "718-545-7771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27-51 27TH STREET",
"city": "ASTORIA",
"state": "NY",
"postal_code": "11102",
"telephone_number": "718-728-0612",
"fax_number": "718-545-7771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEVISTE",
"first_name": "RUSSELL ROY",
"middle_name": "SANTOS",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-08",
"last_updated": "2014-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "035003",
"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 May 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.