Fresh Pond Physical Therapy, P.C

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

015401 Issued in NY

Legal business name

FRESH POND PHYSICAL THERAPY, P.C

Practice address

6805 Fresh Pond Rd
Ridgewood, NY 11385-5200

Phone

(718) 456-2545

Fax

(718) 559-6784

NPI assigned

Jan 4, 2006

Last updated

May 20, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jenny Tan

Title

Billing & Collection Dept. Head

Phone

(718) 456-2543

Specialties & licenses 9

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Fresh Pond Physical Therapy, P.C

  • Physical Therapy Clinic/Center
  • Ridgewood, NY
  • NPI 1962885491
  NPPES parent name

Practitioners 35

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.

• Sheena Marie Tacang Montefrio

  • Physical Therapist
  • Bronx, NY
  • NPI 1790497006
  Medicare reassignment Care Compare group NPD
• Mark Ordona

  • Physical Therapist
  • Brooklyn, NY
  • NPI 1790640498
  Medicare reassignment Care Compare group NPD
• Frahdelyn Salvador

  • Physical Therapist
  • Elmhurst, NY
  • NPI 1407711104
  Medicare reassignment Care Compare group NPD
• Jonathan Zumarraga

  • Physical Therapist
  • Astoria, NY
  • NPI 1619849197
  Medicare reassignment Care Compare group NPD
• Ian Enrick Bartolome

  • Physical Therapist
  • Elmhurst, NY
  • NPI 1083240279
  Medicare reassignment Care Compare group
• Christine Carmille Lucero Espiritu

  • Physical Therapist
  • Rego Park, NY
  • NPI 1851055107
  Medicare reassignment Care Compare group
• Shivaniba Jitendrasinh Gohil, PT

  • Physical Therapist
  • Brooklyn, NY
  • NPI 1063208601
  Medicare reassignment Care Compare group
• Stephanie Hadjail

  • Physical Therapist
  • Ny, NY
  • NPI 1295332377
  Medicare reassignment Care Compare group
• Aram Jed Lim, PT, DPT

  • Physical Therapist
  • Woodside, NY
  • NPI 1902681539
  Medicare reassignment Care Compare group
• Shaira Kaye Luna

  • Physical Therapist
  • Astoria, NY
  • NPI 1518641695
  Medicare reassignment Care Compare group
• Jesubielin Custodio Peronilla, PT

  • Physical Medicine & Rehabilitation Physician
  • Astoria, NY
  • NPI 1174338552
  Medicare reassignment Care Compare group
• Liza Tan, PT, DPT, MA

  • Physical Therapist
  • Ridgewood, NY
  • NPI 1982628764
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463702400000",
    "number": "1508844036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68-05 FRESH POND ROAD",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "11385",
            "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": "6805 FRESH POND RD",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113855200",
            "telephone_number": "718-456-2545",
            "fax_number": "718-559-6784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH POND PHYSICAL THERAPY, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-04",
        "last_updated": "2016-05-20",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "JENNY",
        "authorized_official_title_or_position": "BILLING & COLLECTION DEPT. HEAD",
        "authorized_official_telephone_number": "718-456-2543"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "015401",
            "primary": false
        },
        {
            "code": "2251C2600X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Cardiopulmonary",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251E1300X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Electrophysiology, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251H1200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Hand",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251H1300X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Human Factors",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "015401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "19447P",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02184710",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2666818",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "4C7780",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC/BS",
            "identifier": "QQ1073",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Friendly Connections Inc

• Physical Therapy Clinic/Center in Ridgewood, NY
• Providers in Ridgewood, NY by specialty
• Physical Therapy Clinic/Center 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.