Individual provider Active NPI

Maricel Lactaoen Baetiong, PT

  • Pediatric Physical Therapist
  • Brooklyn, NY
National Provider Identifier
1699087668
Registry record updated Jul 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
023274-01 Issued in NY
Practice address
1651 Coney Island Ave.
Brooklyn, NY 12230
Phone
(718) 998-1415
NPI assigned
Jul 7, 2010
Last updated
Jul 7, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X 023274-01 NY Primary

Addresses

Primary practice location

1651 Coney Island Ave.
Brooklyn, NY 12230

Mailing address

74 Empire Blvd
Island Park, NY 11558-1228
Phone (646) 220-5686

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120604000493 NY Practitioner - Physical Therapist in Private Practice 8921262981 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ober Sarf PT OT PLLCGroup PAC ID 1658751045, 3 clinicians

Practice addresses (Care Compare)

829 Empire Ave
Far Rockaway, NY 11691-4856
Phone (845) 596-1719

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
023274NYMDClinical Child & Adolescent Psychologist
023274-01NYMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Visiting PT OT Services PLLC Pediatrics CurrentSince Apr 28, 2025 Accepting new patients
Patriot Family Medical Associates PLLC CurrentSince Apr 28, 2025 Accepting new patients
Ober Sarf PT OT PLLC Pediatrics CurrentSince Mar 3, 2024 Accepting new patients

Locations

829 Empire Ave
Far Rockaway, NY 11691
Phone (718) 327-2101

85 Roosevelt Ave
Valley Stream, NY 11581
Phone (516) 791-9500

Organizations & group practices 4

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": "1278460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278460800000",
    "number": "1699087668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 EMPIRE BLVD",
            "city": "ISLAND PARK",
            "state": "NY",
            "postal_code": "115581228",
            "telephone_number": "646-220-5686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 CONEY ISLAND AVE.",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "12230",
            "telephone_number": "718-998-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAETIONG",
        "first_name": "MARICEL",
        "middle_name": "LACTAOEN",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-07",
        "last_updated": "2010-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NY",
            "license": "023274-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2010; 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.