NPIMap

Organization Active NPI

Mary Lou Corcoran PT, P.C.

  • Physical Therapy Clinic/Center
  • East Syracuse, NY
National Provider Identifier
1699780338
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
006344-1 Issued in NY
Legal business name
MARY LOU CORCORAN PT, P.C.
Practice address
6711 Towpath Rd Ste 100
East Syracuse, NY 13057-9509
Phone
(315) 637-4747
Fax
(315) 637-6711
NPI assigned
Jul 30, 2006
Last updated
Jun 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Authorized official

Name
Mary Lou Corcoran, PTNPI 1750327763
Title
President
Phone
(315) 637-4747

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 006344-1 NY Primary

Addresses

Primary practice location

6711 Towpath Rd Ste 100
East Syracuse, NY 13057-9509

Mailing address

6711 Towpath Rd Ste 100
East Syracuse, NY 13057-9509
Phone (315) 637-4747

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000810 NY Part B Supplier - Clinic/Group Practice 2668386145 Receives reassigned benefits from 7 practitioners
Practice locations: East Syracuse, NY

National Provider Directory

National Provider Directory

Locations

6711 Towpath Rd
East Syracuse, NY 13057
Phone (315) 637-4747

6711 Towpath Rd
Ste 100
East Syracuse, NY 13057
Phone (315) 637-4747

510 Towne Dr
Ste 100
Fayetteville, NY 13066
Phone (315) 637-4747

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1699780338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6711 TOWPATH RD STE 100",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579509",
            "telephone_number": "315-637-4747",
            "fax_number": "315-637-6711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6711 TOWPATH RD STE 100",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579509",
            "telephone_number": "315-637-4747",
            "fax_number": "315-637-6711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY LOU CORCORAN PT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "CORCORAN",
        "authorized_official_first_name": "MARY LOU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-637-4747",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "006344-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.