Individual provider Active NPI

Nicholas Andrew Kirkpatrick

  • Physical Therapist
  • Old Greenwich, CT
National Provider Identifier
1659619294
Registry record updated Jun 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10117 Issued in CT
Practice address
143 Sound Beach Ave
Old Greenwich, CT 06870-1736
Phone
(203) 817-0196
Fax
(203) 817-0199
NPI assigned
Jan 16, 2013
Sex
Male
Sole proprietor
No

Organizations & group practices 10

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.

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Physical Therapy, Occupational Therapy and Speech Language PA 385 clinicians

Practice addresses (Care Compare)

1311 Mamaroneck Ave
Suite 140
White Plains, NY 10605-5224

36 S Route 9W
Suite 2
West Haverstraw, NY 10993-1049
Phone (845) 579-5677

412 Market St
Nanuet, NY 10954-2744
Phone (914) 370-8071

550 Mamaroneck Ave
Suite 104
Harrison, NY 10528-1612
Phone (914) 777-3737

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140520001278 NY Practitioner - Physical Therapist in Private Practice 4981827979 Reassigns benefits to 1 organization
I20140806001069 CT Practitioner - Physical Therapist in Private Practice 4981827979 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC CurrentSince Jun 9, 2014 Accepting new patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path Physical Therapist CurrentSince Jun 9, 2014 Accepting new patients
Edra Stern MD LLC CurrentSince Feb 12, 2022 Accepting new patients
Ivyrehab Network Inc. Physical Therapist Past Accepting new patients

Locations

1455 E Putnam Ave
Ste 2
Old Greenwich, CT 06870
Phone (203) 661-4242

550 Mamaroneck Ave
Ste 104
Harrison, NY 10528
Phone (914) 777-3737

412 Market St
Nanuet, NY 10954
Phone (347) 741-3619

4175 Veterans Memorial Hwy
Ste 202
Ronkonkoma, NY 11779

4175 Veterans Memorial Hwy
Ronkonkoma, NY 11779

36 S Route 9W
Ste 2
West Haverstraw, NY 10993
Phone (845) 579-5677

1311 Mamaroneck Ave
Ste 140
White Plains, NY 10605
Phone (914) 265-4838

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10117 CT Primary
Physical Therapist 225100000X 035225 NY

Addresses

NPPES NPI Registry

Primary practice location

143 Sound Beach Ave
Old Greenwich, CT 06870-1736

Mailing address

4175 Veterans Memorial Hwy
Ronkonkoma, NY 11779-7639
Phone (631) 580-5200

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 25, 2014.

{
    "created_epoch": "1358294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403654400000",
    "number": "1659619294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4175 VETERANS MEMORIAL HWY",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797639",
            "telephone_number": "631-580-5200",
            "fax_number": "631-580-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 SOUND BEACH AVE",
            "city": "OLD GREENWICH",
            "state": "CT",
            "postal_code": "068701736",
            "telephone_number": "203-817-0196",
            "fax_number": "203-817-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRKPATRICK",
        "first_name": "NICHOLAS",
        "middle_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-16",
        "last_updated": "2014-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "10117",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "035225",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Old Greenwich, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.