NPIMap

Organization Active NPI

Balboa PT

  • Physical Therapist
  • Staten Island, NY
National Provider Identifier
1811276876
Registry record updated Dec 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
0205341 Issued in NY
Legal business name
BALBOA PT
Practice address
945 Huguenot Ave
Staten Island, NY 10312-4312
Phone
(718) 816-6500
Fax
(718) 816-4677
NPI assigned
Aug 9, 2011
Last updated
Dec 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2014

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

Authorized official

Name
Mr. Jason P Lamendola, PTNPI 1619942000
Title
Physical Therapist
Phone
(718) 816-6500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 0205341 NY Primary

Addresses

Primary practice location

945 Huguenot Ave
Staten Island, NY 10312-4312

Mailing address

945 Huguenot Ave
Staten Island, NY 10312-4312
Phone (718) 816-6500

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418169600000",
    "number": "1811276876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 HUGUENOT AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103124312",
            "telephone_number": "718-816-6500",
            "fax_number": "718-816-4677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "945 HUGUENOT AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103124312",
            "telephone_number": "718-816-6500",
            "fax_number": "718-816-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALBOA PT",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-09",
        "last_updated": "2014-12-10",
        "status": "A",
        "authorized_official_last_name": "LAMENDOLA",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "718-816-6500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "0205341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2014; 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.