Bayside Professional PT PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

BAYSIDE PROFESSIONAL PT PC

Practice address

20801 Northern Blvd Ste 301
Bayside, NY 11361-3118

Phone

(718) 224-2250

Fax

(718) 224-2250

NPI assigned

Oct 6, 2025

Organization subpart

No

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

Authorized official

Name

Jaehyun Park, DPTNPI 1114706082

Title

Physical Therapist/Owner

Phone

(718) 224-2250

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jaehyun Park

  • Physical Therapist
  • North Bergen, NJ
  • NPI 1114706082

  NY

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1759708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759708800000",
    "number": "1730054362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20801 NORTHERN BLVD STE 301",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613118",
            "telephone_number": "718-224-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20801 NORTHERN BLVD STE 301",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613118",
            "telephone_number": "718-224-2250",
            "fax_number": "718-224-2250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSIDE PROFESSIONAL PT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-06",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JAEHYUN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "718-224-2250",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Bayside, NY
• Providers in Bayside, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; 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.