Kenneth Mauro, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

020538 Issued in NY

Practice address

475 Northern Blvd Ste 11
Great Neck, NY 11021-4802

Phone

(516) 829-0030

Fax

(516) 466-7723

NPI assigned

Dec 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Matthew Colucci P.T.,P.C.

  • Physical Therapist
  • East Islip, NY
  • NPI 1053472209
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569888000000",
    "number": "1558429845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 NORTHERN BLVD STE 27",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214802",
            "telephone_number": "516-829-0030",
            "fax_number": "516-466-7723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 NORTHERN BLVD STE 11",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214802",
            "telephone_number": "516-829-0030",
            "fax_number": "516-466-7723"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22135 90th Ave",
            "address_purpose": "LOCATION",
            "city": "Queens Village",
            "state": "NY",
            "postal_code": "114281324",
            "country_code": "US",
            "telephone_number": "718-479-9774",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "309 Northwest Dr",
            "address_purpose": "LOCATION",
            "city": "Farmingdale",
            "state": "NY",
            "postal_code": "117354935",
            "country_code": "US",
            "telephone_number": "516-420-2900",
            "fax_number": "516-420-2908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAURO",
        "first_name": "KENNETH",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2019-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "020538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iby Mathews, MS, OTR/L
• Mara Elizabeth Matkovic, M.D.
• Kelly O'Malley Mattone, M.D.
• Kenneth F Mattucci, M.D.
• Thomas Michael Mauri, M.D.
• Kristie Mauro, DPT
• Zenobia Mauro
• Maya's Clinic LLC
• Stephanie Ramos Mayfield, DPT
• Joshua McBriar

• Physical Therapist in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.