Individual provider Active NPI

Redmund TJ Plaza Hinagdanan

  • Physical Therapist
  • Rego Park, NY
National Provider Identifier
1730917006
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
04114801 Issued in NY
Practice address
9712 65TH Rd Apt 15E
Rego Park, NY 11374-3281
Phone
(917) 847-7188
NPI assigned
Jul 26, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 04114801 NY Primary

Addresses

Primary practice location

9712 65TH Rd Apt 15E
Rego Park, NY 11374-3281

Mailing address

9712 65TH Rd Apt 15E
Rego Park, NY 11374-3281
Phone (917) 847-7188

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241010002607 NY Practitioner - Physical Therapist in Private Practice 2860924230 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
04114801NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Outreach Physical and Occupational Therapy & Speech Rehabilitation, PLLC Physical Therapist CurrentSince Sep 9, 2024 Accepting new patients

Locations

3 Grace Ave
Ste 119
Great Neck, NY 11021
Phone (212) 842-0080

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1721952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721952000000",
    "number": "1730917006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9712 65TH RD APT 15E",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113743281",
            "telephone_number": "917-847-7188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9712 65TH RD APT 15E",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113743281",
            "telephone_number": "917-847-7188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HINAGDANAN",
        "first_name": "REDMUND TJ",
        "middle_name": "PLAZA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-26",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "04114801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; 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.