Individual provider Active NPI

Dana Sudran, PT, DPT

  • Orthopedic Physical Therapist
  • Oceanside, NY
National Provider Identifier
1871934471
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
035114 Issued in NY
Practice address
15 Neil CT
Oceanside, NY 11572-5815
Phone
(516) 766-0505
Fax
(516) 766-0680
NPI assigned
Jul 11, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 035114 NY Primary

Addresses

Primary practice location

15 Neil CT
Oceanside, NY 11572-5815

Mailing address

15 Neil CT
Oceanside, NY 11572-5815
Phone (516) 766-0505

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210914002433 NY Practitioner - Physical Therapist in Private Practice 1759787955 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
035114NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Therapy and Aquatics by the Sea, PLLC Physical Therapist CurrentSince Jul 1, 2021 Accepting new patients

Locations

800 E Gate Blvd
Garden City, NY 11530

309 W Park Ave
Long Beach, NY 11561
Phone (516) 568-7858

11 Neil Ct
Oceanside, NY 11572
Phone (516) 766-0505

15 Neil Ct
Oceanside, NY 11572
Phone (516) 603-8995

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.

NPI Registry JSON

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

{
    "created_epoch": "1373500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1871934471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 NEIL CT",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115725815",
            "telephone_number": "516-766-0505",
            "fax_number": "516-766-0680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 NEIL CT",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115725815",
            "telephone_number": "516-766-0505",
            "fax_number": "516-766-0680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDRAN",
        "first_name": "DANA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-11",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NY",
            "license": "035114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oceanside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.