NPIMap

Organization Active NPI

Executive Park Orthopedic & Sports Physical Therapy LLC

  • Orthopedic Physical Therapist
  • Yonkers, NY
National Provider Identifier
1649392283
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
023806 Issued in NY
Legal business name
EXECUTIVE PARK ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC
Practice address
1034 N Broadway
2ND Floor
Yonkers, NY 10701-1303
Phone
(914) 509-4640
Fax
(914) 509-4639
NPI assigned
Apr 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Authorized official

Name
Mr. Ivan Hernandez, DPTNPI 1891886438
Title
President
Phone
(914) 509-4640

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
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X 023806 NY Primary

Addresses

Primary practice location

1034 N Broadway
2ND Floor
Yonkers, NY 10701-1303

Mailing address

1034 N Broadway
2ND Floor
Yonkers, NY 10701-1328
Phone (914) 509-4640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111110000515 NY DME Supplier - Independently-Practicing Physical Therapist 4385818293 Practice locations: Yonkers, NY
O20180807002852 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4385818293 Receives reassigned benefits from 2 practitioners
Practice locations: Yonkers, NY

National Provider Directory

National Provider Directory
Tax ID family
Executive Park Orthopedic and Sports PT2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1034 N Broadway
Ste 204
Yonkers, NY 10701
Phone (914) 509-4640

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713830400000",
    "number": "1649392283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 N BROADWAY",
            "address_2": "2ND FLOOR",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107011328",
            "telephone_number": "914-509-4640",
            "fax_number": "914-509-4639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 N BROADWAY",
            "address_2": "2ND FLOOR",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107011303",
            "telephone_number": "914-509-4640",
            "fax_number": "914-509-4639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE PARK ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "914-509-4640",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NY",
            "license": "023806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yonkers, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; 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.