Organization Active NPI

St Maurice Physical Therapy PC

  • Physical Therapist
  • Westbury, NY
National Provider Identifier
1588017677
Registry record updated Jul 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
033723 Issued in NY
Legal business name
ST MAURICE PHYSICAL THERAPY PC
Practice address
899 Bowling Green Dr
Westbury, NY 11590-6103
Phone
(347) 656-6998
NPI assigned
Jul 13, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2016

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

Authorized official

Name
Micheal Bakhom, DPT
Title
Agent
Phone
(347) 656-6998

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 033723 NY Primary

Addresses

Primary practice location

899 Bowling Green Dr
Westbury, NY 11590-6103

Mailing address

899 Bowling Green Dr
Westbury, NY 11590-6103
Phone (347) 656-6998

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160930001469 NY Part B Supplier - Clinic/Group Practice 1456648666 Receives reassigned benefits from 4 practitioners
Practice locations: Farmingdale, NY; New City, NY; Ridgewood, NY; Woodbury, NY

National Provider Directory

National Provider Directory

Locations

182 S Main St
#109
New City, NY 10956

500 Todt Hill Rd
Staten Island, NY 10304
Phone (330) 550-0258

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1468368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468800000000",
    "number": "1588017677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "899 BOWLING GREEN DR",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115906103",
            "telephone_number": "347-656-6998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "899 BOWLING GREEN DR",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115906103",
            "telephone_number": "347-656-6998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MAURICE PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-13",
        "last_updated": "2016-07-18",
        "status": "A",
        "authorized_official_last_name": "BAKHOM",
        "authorized_official_first_name": "MICHEAL",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "347-656-6998",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "033723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westbury, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 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.