Active NPI
Theda Lumagod Shishkin, PT
- Physical Therapist
- Bronx, NY
National Provider Identifier
1861896722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 032313
- Practice address
- 817 E 180TH St
Bronx, NY 10460-1305 - Phone
- (718) 220-6262
- Fax
- (718) 355-9652
- NPI assigned
- Oct 21, 2014
- Sex
- Female
- Sole proprietor
- No
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 | 032313 | NY | Primary |
Addresses
Primary practice location
817 E 180TH St
Bronx, NY 10460-1305
Mailing address
7945 Grand Ave
Elmhurst, NY 11373-4129
Phone (347) 320-0155
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 |
|---|---|---|---|
| 032313 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shishkin Physical Therapy Rehab PC | Physical Therapist | Current | Accepting new patients |
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
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.
-
- Physical Therapist
- New York, NY
- NPI 1649874405
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480377600000",
"number": "1861896722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7945 GRAND AVE",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113734129",
"telephone_number": "347-320-0155",
"fax_number": "718-355-9652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "817 E 180TH ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104601305",
"telephone_number": "718-220-6262",
"fax_number": "718-355-9652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHISHKIN",
"first_name": "THEDA",
"middle_name": "LUMAGOD",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-21",
"last_updated": "2016-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "032313",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.