Active NPI
Lakshmi Charitha Jidugu, PT
- Physical Therapist
- New York, NY
National Provider Identifier
1588926315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 030712
- Practice address
- 1970 Adam Clayton Powell Jr Blvd
New York, NY 10026-1723 - Phone
- (212) 864-1500
- Fax
- (212) 864-0500
- NPI assigned
- Jun 7, 2012
- Sex
- Female
- Sole proprietor
- No
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 | 030712 | NY | Primary |
Addresses
Primary practice location
1970 Adam Clayton Powell Jr Blvd
New York, NY 10026-1723
Mailing address
174 Grand St
White Plains, NY 10601-4803
Phone (914) 328-8077
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030712 | NY | MD | Oral and Maxillofacial Pathology Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Imperial Vista Health Care Staffing, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Occupational Therapist
- Lodi, NJ
- NPI 1003211152
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352160000000",
"number": "1588926315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "174 GRAND ST",
"city": "WHITE PLAINS",
"state": "NY",
"postal_code": "106014803",
"telephone_number": "914-328-8077",
"fax_number": "914-328-6083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1970 ADAM CLAYTON POWELL JR BLVD",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100261723",
"telephone_number": "212-864-1500",
"fax_number": "212-864-0500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIDUGU",
"first_name": "LAKSHMI",
"middle_name": "CHARITHA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-07",
"last_updated": "2012-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "030712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.