Aleksandr Degtyarev, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

032816 Issued in NY

Practice address

318 Wynn LN
Port Jefferson, NY 11777-1670

Phone

(917) 224-0464

NPI assigned

Jun 13, 2023

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

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

{
    "created_epoch": "1686614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1619651387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 WESTCHESTER DR",
            "city": "ROCKY POINT",
            "state": "NY",
            "postal_code": "117788875",
            "telephone_number": "917-224-0464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 WYNN LN",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771670",
            "telephone_number": "917-224-0464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGTYAREV",
        "first_name": "ALEKSANDR",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-13",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "032816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ismael V. David, M.D.
• Ryan Davis, DDS
• Reubin Pooya Davoudzadeh, M.D.
• Carolina Belen De Elia
• Kim Decastro, CNP, CNM
• Erin Michele Delio
• Matthew Delph, PA
• Jessica Marie Demaria
• Peter G Depasquale, PHD MSW
• Toni B Derman, LCSW

• Massage Therapist in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Massage Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; 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.