Active NPI
Alexander Guillera
- Physical Therapy Clinic/Center
- Ridgewood, NY
National Provider Identifier
1598137267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 039432-1
- Practice address
- 6805 Fresh Pond Rd
Ridgewood, NY 11385-5200 - Phone
- (718) 456-2545
- Fax
- (718) 559-6784
- NPI assigned
- Oct 21, 2015
- Sex
- Male
- 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 Therapy Clinic/Center | 261QP2000X | 039432-1 | NY | Primary |
Addresses
Primary practice location
6805 Fresh Pond Rd
Ridgewood, NY 11385-5200
Mailing address
6805 Fresh Pond Rd
Ridgewood, NY 11385-5200
Phone (718) 456-2545
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 |
|---|---|---|---|
| 039432-1 | NY | MD | Physical Therapy Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445385600000",
"number": "1598137267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6805 FRESH POND RD",
"city": "RIDGEWOOD",
"state": "NY",
"postal_code": "113855200",
"telephone_number": "718-456-2545",
"fax_number": "718-559-6784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6805 FRESH POND RD",
"city": "RIDGEWOOD",
"state": "NY",
"postal_code": "113855200",
"telephone_number": "718-456-2545",
"fax_number": "718-559-6784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUILLERA",
"first_name": "ALEXANDER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-21",
"last_updated": "2015-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "NY",
"license": "039432-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgewood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.