Kevin Phelan

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

007659

Practice address

94 W Main St
Bay Shore, NY 11706-8365

Phone

(631) 983-3724

NPI assigned

Nov 24, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1637712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1689331613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 BROADHOLLOW RD STE PROEX",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117475002",
            "telephone_number": "631-359-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 W MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068365",
            "telephone_number": "631-983-3724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELAN",
        "first_name": "KEVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-24",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": "007659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Peterson, MD
• Daniella Petrini, MSW
• Amanda Marie Petrone, LPN
• Sheniel Freedom Phagoo
• Carol Ann Phelan, R.N.
• Philip Kaplan, MD, PC
• Neubert Philippe, MD
• Douglas R Phillips, MD
• Mandy Phillips, BCBA
• Emmanuel Philogene

• Physical Therapy Assistant in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.