Active NPI
Eva Agnes Mikrut, DPT
- Physical Therapist
- Maspeth, NY
National Provider Identifier
1548416035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 003555-1
- Practice address
- 6024 60TH Dr
Apt #3C
Maspeth, NY 11378-3500 - Phone
- (917) 482-4597
- NPI assigned
- Aug 15, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | 003555-1 | NY | Primary |
Addresses
Primary practice location
6024 60TH Dr
Apt #3C
Maspeth, NY 11378-3500
Mailing address
6024 60TH Dr
Apt #3C
Maspeth, NY 11378-3500
Phone (917) 482-4597
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003555-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296172800000",
"number": "1548416035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6024 60TH DR",
"address_2": "APT #3C",
"city": "MASPETH",
"state": "NY",
"postal_code": "113783500",
"telephone_number": "917-482-4597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6024 60TH DR",
"address_2": "APT #3C",
"city": "MASPETH",
"state": "NY",
"postal_code": "113783500",
"telephone_number": "917-482-4597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKRUT",
"first_name": "EVA",
"middle_name": "AGNES",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-15",
"last_updated": "2011-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "003555-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maspeth, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.