Jivan Ray Leonida Resano, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

014020 Issued in NY

Practice address

9128 Park LN S
Woodhaven, NY 11421-1432

Phone

(808) 342-4208

NPI assigned

Dec 11, 2023

Last updated

Dec 11, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. J Ivan Ray Leonida Resano Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1702252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1659148542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9128 PARK LN S",
            "city": "WOODHAVEN",
            "state": "NY",
            "postal_code": "114211432",
            "telephone_number": "808-342-4208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9128 PARK LN S",
            "city": "WOODHAVEN",
            "state": "NY",
            "postal_code": "114211432",
            "telephone_number": "808-342-4208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RESANO",
        "first_name": "JIVAN RAY",
        "middle_name": "LEONIDA",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-11",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "014020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "J IVAN RAY",
            "last_name": "RESANO",
            "middle_name": "LEONIDA",
            "prefix": "MR.",
            "credential": "PTA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Thomas Anthony Randazzo, RPH
• Tariq Rasheed, DPM
• Ashley Rasiawan
• Chandra Wattie Rasiawan
• Thomas M Reilly, MD
• Angie Reyes
• Rey Pablo Reyes
• Rite Aid of New York Inc (Rite Aid Pharmacy 04610)
• Veronica Rivera, MS, LCAT, BC-DMT
• Robby Short, MD PC

• Physical Therapy Assistant in Woodhaven, NY
• Providers in Woodhaven, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.