Active NPI
Russell Taveras, PT
- Physical Therapist
- Patchogue, NY
National Provider Identifier
1669587465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 0270991
- Practice address
- 79 E Main St
Patchogue, NY 11772-3101 - Phone
- (631) 289-0088
- Fax
- (631) 289-6177
- NPI assigned
- Aug 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0270991 | NY | Primary |
Addresses
Primary practice location
79 E Main St
Patchogue, NY 11772-3101
Mailing address
79 E Main St
Ste I
Patchogue, NY 11772-3101
Phone (631) 289-0088
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120730000199 | NY | Practitioner - Physical Therapist in Private Practice | 2567628985 | Practice locations: Patchogue, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- State University of New York at Stony Brook, School of Medicine, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
38 Oak St
Suite 2
Patchogue, NY 11772-2883
Phone (631) 654-2225
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0270991 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331078400000",
"number": "1669587465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "79 E MAIN ST",
"address_2": "STE I",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117723101",
"telephone_number": "631-289-0088",
"fax_number": "631-289-6177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 E MAIN ST",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117723101",
"telephone_number": "631-289-0088",
"fax_number": "631-289-6177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAVERAS",
"first_name": "RUSSELL",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-20",
"last_updated": "2012-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "0270991",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Patchogue, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2012; 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.