Active NPI
Charles Gennaro, PHYSICAL THERAPIST
- Physical Therapist
- Manorville, NY
National Provider Identifier
1861564825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 024052
- Practice address
- 221 N Sunrise Service Rd
Manorville, NY 11949-9604 - Phone
- (631) 878-8900
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 024052 | NY | Primary |
Addresses
Primary practice location
221 N Sunrise Service Rd
Manorville, NY 11949-9604
Mailing address
221 N Sunrise Service Rd
Manorville, NY 11949-9604
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024052 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Long Island Select Healthcare, Inc. | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CCJFAD
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Central Islip, NY
- NPI 1043663107
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788134400000",
"number": "1861564825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221 N SUNRISE SERVICE RD",
"city": "MANORVILLE",
"state": "NY",
"postal_code": "119499604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 N SUNRISE SERVICE RD",
"city": "MANORVILLE",
"state": "NY",
"postal_code": "119499604",
"telephone_number": "631-878-8900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENNARO",
"first_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2026-08-31",
"certification_date": "2026-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "024052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Manorville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.