Active NPI
Kenta Miyazaki, MS, ATC
- Athletic Trainer
- Plattsburgh, NY
National Provider Identifier
1669911517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 002627-1
- Practice address
- 101 Broad Street
Suny Plattsburgh,
Plattsburgh, NY 12901 - Phone
- (518) 564-3089
- NPI assigned
- Feb 13, 2017
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 002627-1 | NY | Primary |
Addresses
Primary practice location
101 Broad Street
Suny Plattsburgh,
Plattsburgh, NY 12901
Mailing address
101 Broad Street
Suny Plattsburgh,
Plattsburgh, NY 12901
Phone (518) 564-3089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002627-1 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486944000000",
"number": "1669911517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 BROAD STREET",
"address_2": "SUNY PLATTSBURGH,",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "12901",
"telephone_number": "518-564-3089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 BROAD STREET",
"address_2": "SUNY PLATTSBURGH,",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "12901",
"telephone_number": "518-564-3089"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIYAZAKI",
"first_name": "KENTA",
"credential": "MS, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-13",
"last_updated": "2017-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "002627-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plattsburgh, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.