Individual provider Active NPI

Glen Irving Nykwest, D.C

  • Orthopedic Chiropractor
  • Pleasantville, NY
National Provider Identifier
1962556456
Registry record updated Nov 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic ChiropractorTaxonomy code 111NX0800X
License
X002303-1 Issued in NY
Practice address
106 Washington Avenue
Pleasantville, NY 10570
Phone
(914) 273-5505
Fax
(914) 273-6519
NPI assigned
Jan 22, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Chiropractor 111NX0800X X002303-1 NY Primary

Addresses

Primary practice location

106 Washington Avenue
Pleasantville, NY 10570

Mailing address

106 Washington Avenue
Pleasantville, NY 10570
Phone (914) 273-5505

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120119000108 NY Practitioner - Chiropractic 1153598933 Practice locations: Pleasantville, NY

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1979
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

106 Washington Ave
Pleasantville, NY 10570-2854
Phone (914) 273-5505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
X002303-1NYMDOrthopedic Chiropractor
002303NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pleasantville Smiles Dentistry LLC PastSince Sep 23, 2024 Accepting new patients

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": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479168000000",
    "number": "1962556456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 WASHINGTON AVENUE",
            "city": "PLEASANTVILLE",
            "state": "NY",
            "postal_code": "10570",
            "telephone_number": "914-273-5505",
            "fax_number": "914-273-6519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 WASHINGTON AVENUE",
            "city": "PLEASANTVILLE",
            "state": "NY",
            "postal_code": "10570",
            "telephone_number": "914-273-5505",
            "fax_number": "914-273-6519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYKWEST",
        "first_name": "GLEN",
        "middle_name": "IRVING",
        "name_prefix": "Dr.",
        "credential": "D.C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2016-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "NY",
            "license": "X002303-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasantville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.