NPIMap

Organization Active NPI

Agewell Physical Therapy and Wellness, P.C.

  • Physical Therapist
  • Lake Success, NY
National Provider Identifier
1861485070
Registry record updated Mar 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
0155321 Issued in NY
Legal business name
AGEWELL PHYSICAL THERAPY AND WELLNESS, P.C.
Practice address
1999 Marcus Ave
Suite M15
Lake Success, NY 11042-1013
Phone
(516) 488-8808
Fax
(516) 488-8818
NPI assigned
Aug 24, 2005
Last updated
Mar 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2008

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

Authorized official

Name
Mr. Mark Herbrich, P.T.NPI 1619922952
Title
Co-Founder/ Physical Therapist
Phone
(516) 488-8808

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 0155321 NY Primary

Addresses

Primary practice location

1999 Marcus Ave
Suite M15
Lake Success, NY 11042-1013

Mailing address

1999 Marcus Ave
Suite M15
Lake Success, NY 11042-1013
Phone (516) 488-8808

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040825001725 NY Part B Supplier - Clinic/Group Practice 6507830361 Receives reassigned benefits from 7 practitioners
Practice locations: New Hyde Park, NY

National Provider Directory

National Provider Directory

Locations

5155 S Durango Dr
Ste 101
Las Vegas, NV 89113
Phone (702) 478-2424

Practitioners & affiliated clinicians

Practitioners 7

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": "1124841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205366400000",
    "number": "1861485070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1999 MARCUS AVE",
            "address_2": "SUITE M15",
            "city": "LAKE SUCCESS",
            "state": "NY",
            "postal_code": "110421013",
            "telephone_number": "516-488-8808",
            "fax_number": "516-488-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1999 MARCUS AVE",
            "address_2": "SUITE M15",
            "city": "LAKE SUCCESS",
            "state": "NY",
            "postal_code": "110421013",
            "telephone_number": "516-488-8808",
            "fax_number": "516-488-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGEWELL PHYSICAL THERAPY AND WELLNESS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-24",
        "last_updated": "2008-03-13",
        "status": "A",
        "authorized_official_last_name": "HERBRICH",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CO-FOUNDER/ PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "516-488-8808",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "0155321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Success, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; 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.