NPIMap

Organization Active NPI

Pain and Rehabilitation Medical Specialists, PC

  • Specialist
  • Freeport, NY
National Provider Identifier
1952406985
Registry record updated Sep 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
221976 Issued in NY
Legal business name
PAIN AND REHABILITATION MEDICAL SPECIALISTS, PC
Practice address
73 Guy Lombardo Ave
Freeport, NY 11520-3714
Phone
(516) 377-3332
Fax
(516) 377-3844
NPI assigned
Sep 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2014

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

Authorized official

Name
Juan Ledon, MDNPI 1093825499
Title
President
Phone
(516) 377-3332

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
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 221976 NY Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X 244683 NY
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 026755 NY

Addresses

Primary practice location

73 Guy Lombardo Ave
Freeport, NY 11520-3714

Mailing address

73 Guy Lombardo Ave
Freeport, NY 11520-3714
Phone (516) 377-3332

Other identifiers 1

IdentifierTypeStateIssuer
02699567MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040601001421 NY Part B Supplier - Clinic/Group Practice 8921080300 Receives reassigned benefits from 5 practitioners
Practice locations: Bay Shore, NY; Freeport, NY; Hicksville, NY

National Provider Directory

National Provider Directory

Locations

73 Guy Lombardo Ave
Freeport, NY 11520
Phone (516) 377-3332

Practitioners & affiliated clinicians

Practitioners 9

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": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409788800000",
    "number": "1952406985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 GUY LOMBARDO AVE",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115203714",
            "telephone_number": "516-377-3332",
            "fax_number": "516-377-3844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 GUY LOMBARDO AVE",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115203714",
            "telephone_number": "516-377-3332",
            "fax_number": "516-377-3844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN AND REHABILITATION MEDICAL SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2014-09-04",
        "status": "A",
        "authorized_official_last_name": "LEDON",
        "authorized_official_first_name": "JUAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-377-3332",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "221976",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NY",
            "license": "244683",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "026755",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02699567",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Freeport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; 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.