Organization Active NPI

Prescription Exercise LLC

  • Physical Therapist
  • Port Jefferson Station, NY
National Provider Identifier
1528831740
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PRESCRIPTION EXERCISE LLC
Practice address
6 Roosevelt Ave
Port Jefferson Station, NY 11776-3364
Phone
(631) 509-0910
Fax
(631) 509-0911
NPI assigned
Oct 31, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Authorized official

Name
Liz Cruz
Title
Manager
Phone
(516) 445-8799

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

6 Roosevelt Ave
Port Jefferson Station, NY 11776-3364

Mailing address

6 Roosevelt Ave
Port Jefferson Station, NY 11776-3364
Phone (631) 509-0910

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240308000069 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8325484777 Receives reassigned benefits from 1 practitioner
Practice locations: Port Jefferson Station, NY

National Provider Directory

National Provider Directory

Locations

6 Roosevelt Ave
Port Jefferson Station, NY 11776
Phone (631) 474-1533

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1698710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1528831740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 ROOSEVELT AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763364",
            "telephone_number": "631-509-0910",
            "fax_number": "631-509-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 ROOSEVELT AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763364",
            "telephone_number": "631-509-0910",
            "fax_number": "631-509-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCRIPTION EXERCISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-31",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "LIZ",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "516-445-8799"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.