NPIMap

Organization Active NPI

New York Sports Spine Pain Medicine P.C.

  • Physical Medicine & Rehabilitation Physician
  • Jamaica, NY
National Provider Identifier
1851072607
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
NEW YORK SPORTS SPINE PAIN MEDICINE P.C.
Practice address
12620 101St Ave
Jamaica, NY 11419-1547
Phone
(718) 322-4145
NPI assigned
Jul 25, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

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

Authorized official

Name
Sanjeev Agarwal, MDNPI 1154487528
Title
President
Phone
(347) 920-8375

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081S0010X

Addresses

Primary practice location

12620 101St Ave
Jamaica, NY 11419-1547

Mailing address

1 Sheridan Rd
Scarsdale, NY 10583-1524
Phone (347) 920-8375

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20231010001796 NY Part B Supplier - Clinic/Group Practice 6204281314 Receives reassigned benefits from 8 practitioners
Practice locations: Jamaica, NY; South Richmond Hill, NY
O20240927001942 NY DME Supplier - Physician - Physical and Rehabilitation 6204281314 Practice locations: South Richmond Hill, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1690243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690243200000",
    "number": "1851072607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SHERIDAN RD",
            "city": "SCARSDALE",
            "state": "NY",
            "postal_code": "105831524",
            "telephone_number": "347-920-8375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12620 101ST AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114191547",
            "telephone_number": "718-322-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK SPORTS SPINE PAIN MEDICINE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-25",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A",
        "authorized_official_last_name": "AGARWAL",
        "authorized_official_first_name": "SANJEEV",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "347-920-8375",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; 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.