Individual provider Active NPI

Michal J Niedzielski, P.T.

  • Physical Therapist
  • Horseheads, NY
National Provider Identifier
1679506133
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
014843 Issued in NY
Practice address
2977 Westinghouse Rd
Horseheads, NY 14845-8120
Phone
(607) 795-1539
Fax
(607) 795-1918
NPI assigned
Jul 8, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 014843 NY Primary

Addresses

Primary practice location

2977 Westinghouse Rd
Horseheads, NY 14845-8120

Mailing address

111 E 14TH St
Elmira, NY 14903-1303
Phone (607) 734-9539

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111219000015 NY Practitioner - Physical Therapist in Private Practice 1557301736 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Horseheads Comprehensive Physical Therapy PC CorpGroup PAC ID 4183879661, 2 clinicians

Practice addresses (Care Compare)

2758 Westinghouse Rd
Horseheads, NY 14845-8115
Phone (607) 795-1539

2758 Westinghouse Rd
Horseheads, NY 14845-8120

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
014843NYMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Horseheads Comprehensive Physical Therapy, PC, Corp Physical Therapist CurrentSince Apr 30, 2003 Accepting new patients
Flow Form Function Physical Therapy, PLLC Physical Therapist Past Accepting new patients
Physical Therapy Center of Horseheads Physical Therapist PastSince Jan 21, 1997 Accepting new patients

Locations

2758 Westinghouse Rd
Horseheads, NY 14845
Phone (607) 795-1539

2977 Westinghouse Rd
Horseheads, NY 14845
Phone (607) 378-6662

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679506133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 14TH ST",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149031303",
            "telephone_number": "607-734-9539",
            "fax_number": "607-734-6293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2977 WESTINGHOUSE RD",
            "city": "HORSEHEADS",
            "state": "NY",
            "postal_code": "148458120",
            "telephone_number": "607-795-1539",
            "fax_number": "607-795-1918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEDZIELSKI",
        "first_name": "MICHAL",
        "middle_name": "J",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "014843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Horseheads, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.