NPIMap

Organization Active NPI

Costa Physical Therapy, P.C.

  • Specialist
  • Smithtown, NY
National Provider Identifier
1629355490
Registry record updated Nov 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
009869 Issued in NY
Legal business name
COSTA PHYSICAL THERAPY, P.C.
Practice address
269 E Main St
Suite E3
Smithtown, NY 11787-2832
Phone
(631) 724-3150
Fax
(631) 724-3117
NPI assigned
Nov 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2011

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

Authorized official

Name
Mr. James J Costa, PHYSICAL THERAPISTNPI 1790857647
Title
Director/Owner
Phone
(631) 724-3150

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 009869 NY Primary

Addresses

Primary practice location

269 E Main St
Suite E3
Smithtown, NY 11787-2832

Mailing address

269 E Main St
Suite E3
Smithtown, NY 11787-2832
Phone (631) 724-3150

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111209000237 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9931374527 Receives reassigned benefits from 1 practitioner
Practice locations: Smithtown, NY

National Provider Directory

National Provider Directory

Locations

267 E Main St
Ste B5
Smithtown, NY 11787
Phone (631) 724-3150

269 E Main St
Ste E3
Smithtown, NY 11787
Phone (631) 724-3150

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1320710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320710400000",
    "number": "1629355490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 E MAIN ST",
            "address_2": "SUITE E3",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872832",
            "telephone_number": "631-724-3150",
            "fax_number": "631-724-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 E MAIN ST",
            "address_2": "SUITE E3",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872832",
            "telephone_number": "631-724-3150",
            "fax_number": "631-724-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTA PHYSICAL THERAPY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-08",
        "last_updated": "2011-11-08",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "631-724-3150",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "009869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2011; 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.