John-Rex Pascual Meneses, MSPT

Key facts

NPI

1790409191

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Clinic/Center 261QP2000X

License

019119 (NY)

Practice address

27 Cottonwood Dr
Commack, NY 11725-2420

Phone

(516) 769-5250

NPI assigned

Sep 29, 2022

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 29, 2022.

{
    "created_epoch": "1664409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1790409191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 COTTONWOOD DR",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252420",
            "telephone_number": "516-769-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 COTTONWOOD DR",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252420",
            "telephone_number": "516-769-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENESES",
        "first_name": "JOHN-REX",
        "middle_name": "PASCUAL",
        "name_prefix": "Mr.",
        "credential": "MSPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-29",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "019119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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