Med Physical Therapy PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0155911 Issued in NY

Legal business name

MED PHYSICAL THERAPY PC

Practice address

775 Park Ave
Suite 200-12
Huntington, NY 11743

Phone

(631) 385-0066

Fax

(631) 385-0770

NPI assigned

Jul 12, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Farhad Haeri, PT DPT

Title

Physical Therapy Director

Phone

(631) 385-0066

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205280000000",
    "number": "1790984425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 WESTMINSTER AVE",
            "city": "DIX HILLS",
            "state": "NY",
            "postal_code": "11746",
            "telephone_number": "631-385-0066",
            "fax_number": "631-385-0770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 PARK AVE",
            "address_2": "SUITE 200-12",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "11743",
            "telephone_number": "631-385-0066",
            "fax_number": "631-385-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-12",
        "last_updated": "2008-03-12",
        "status": "A",
        "authorized_official_last_name": "HAERI",
        "authorized_official_first_name": "FARHAD",
        "authorized_official_title_or_position": "PHYSICAL THERAPY DIRECTOR",
        "authorized_official_telephone_number": "631-385-0066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "0155911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02019134",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Huntington, NY
• Providers in Huntington, 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 Mar 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.