Active NPI
Kerry Mogavero
- Physical Therapy Assistant
- Roosevelt, NY
National Provider Identifier
1700437860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 0054791
- Practice address
- 380 Washington Ave
Roosevelt, NY 11575-1845 - Phone
- (516) 378-2000
- NPI assigned
- Sep 20, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 0054791 | NY | Primary |
Addresses
Primary practice location
380 Washington Ave
Roosevelt, NY 11575-1845
Mailing address
2 Lotus LN
Westbury, NY 11590-6321
Phone (516) 996-0704
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0054791 | NY | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623283200000",
"number": "1700437860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 LOTUS LN",
"city": "WESTBURY",
"state": "NY",
"postal_code": "115906321",
"telephone_number": "516-996-0704",
"fax_number": "516-377-2098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "380 WASHINGTON AVE",
"city": "ROOSEVELT",
"state": "NY",
"postal_code": "115751845",
"telephone_number": "516-378-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOGAVERO",
"first_name": "KERRY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-20",
"last_updated": "2021-06-10",
"certification_date": "2021-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "0054791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roosevelt, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.