Individual provider Active NPI

Daniel Dominick Agnese, PT, DPT, CSCS

  • Physical Therapist
  • Ithaca, NY
National Provider Identifier
1629397641
Registry record updated Jun 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
030031-1 Issued in NY
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

Updated by the provider on Jun 1, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
00332729MedicaidNY

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

LicenseStateTypeSpecialty
030031-1NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew 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.

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.

Verify at the official NPI Registry.