NPIMap

Organization Active NPI

TLC Clove Lake Physical Therapy PC

  • Physical Therapist
  • Staten Island, NY
National Provider Identifier
1659549715
Registry record updated Feb 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
TLC CLOVE LAKE PHYSICAL THERAPY PC
Practice address
1428 Victory Blvd
Staten Island, NY 10301-3908
Phone
(718) 698-3055
Fax
(718) 448-1875
NPI assigned
Feb 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2008

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

Authorized official

Name
Dr. Toa Chris Wong, PTNPI 1053357723
Title
Director
Phone
(718) 238-9392

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
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1428 Victory Blvd
Staten Island, NY 10301-3908

Mailing address

1428 Victory Blvd
Staten Island, NY 10301-3908
Phone (718) 698-3055

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080417000128 NY Part B Supplier - Clinic/Group Practice 6406934389 Receives reassigned benefits from 4 practitioners
Practice locations: Staten Island, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1202774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202774400000",
    "number": "1659549715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1428 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103013908",
            "telephone_number": "718-698-3055",
            "fax_number": "718-448-1875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1428 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103013908",
            "telephone_number": "718-698-3055",
            "fax_number": "718-448-1875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC CLOVE LAKE PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-12",
        "last_updated": "2008-02-12",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "TOA",
        "authorized_official_middle_name": "CHRIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "718-238-9392",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; 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.