Kevin Roden, PT OCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

072841 Issued in NY

Practice address

607 Middle Country Rd
Coram, NY 11727-3362

Phone

(631) 732-3900

Fax

(631) 732-3908

NPI assigned

Feb 22, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Physical Therapist in Private Practice

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Island Sports Physical Therapy of Coram PC

  • Physical Therapist
  • Coram, NY
  • NPI 1083681613
  NPD Authorized official

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294185600000",
    "number": "1730154899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 MIDDLE COUNTRY ROAD",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "11727",
            "telephone_number": "631-732-3900",
            "fax_number": "631-732-3908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 MIDDLE COUNTRY RD",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117273362",
            "telephone_number": "631-732-3900",
            "fax_number": "631-732-3908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODEN",
        "first_name": "KEVIN",
        "name_prefix": "Mr.",
        "credential": "PT OCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2011-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "072841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "5076437",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "0903230",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carly Patrice Rieck, MSED
• Mary Ringlen, LCSW
• William Rivas
• Danielle Theresa Robeants
• Jennifer A. Robins, RD
• Tyler Roden
• Lisa Marie Rodriguez, LPN
• Bianca Roland
• Kelly Ann Roman, LPN
• Aubrey Romano, LCSW

• Physical Therapist in Coram, NY
• Providers in Coram, 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 Jan 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.