Active NPI
Daniel Dominick Agnese, PT, DPT, CSCS
- Physical Therapist
- Ithaca, NY
National Provider Identifier
1629397641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 030031-1
- Practice address
- 310 Taughannock Blvd Ste 1C
Ithaca, NY 14850-3251 - Phone
- (607) 252-3500
- Fax
- (607) 252-3505
- NPI assigned
- Jun 1, 2010
- Sex
- Male
- 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 | 030031-1 | NY | Primary |
Addresses
Primary practice location
310 Taughannock Blvd Ste 1C
Ithaca, NY 14850-3251
Mailing address
310 Taughannock Blvd Ste 1C
Ithaca, NY 14850-3251
Phone (607) 252-3500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00332729 | Medicaid | NY |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030031-1 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cayuga Medical Center | 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.
-
- General Acute Care Hospital
- Ithaca, NY
- NPI 1811210388
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275350400000",
"number": "1629397641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 TAUGHANNOCK BLVD STE 1C",
"city": "ITHACA",
"state": "NY",
"postal_code": "148503251",
"telephone_number": "607-252-3500",
"fax_number": "607-252-3505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 TAUGHANNOCK BLVD STE 1C",
"city": "ITHACA",
"state": "NY",
"postal_code": "148503251",
"telephone_number": "607-252-3500",
"fax_number": "607-252-3505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGNESE",
"first_name": "DANIEL",
"middle_name": "DOMINICK",
"credential": "PT, DPT, CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-06-01",
"last_updated": "2010-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "030031-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00332729",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.