NPIMap

Organization Active NPI

North Fork Physical Therapy PC

  • Physical Therapy Clinic/Center
  • Riverhead, NY
National Provider Identifier
1972655041
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
019081-1 Issued in NY
Legal business name
NORTH FORK PHYSICAL THERAPY PC
Practice address
31 Main Rd
Suite 4
Riverhead, NY 11901-1953
Phone
(631) 208-2900
Fax
(631) 208-2929
NPI assigned
Jan 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Marc P Wahl, PTNPI 1477601649
Title
Physical Therapist
Phone
(631) 208-2900

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 019081-1 NY Primary

Addresses

Primary practice location

31 Main Rd
Suite 4
Riverhead, NY 11901-1953

Mailing address

PO Box 2442
Aquebogue, NY 11931-2442
Phone (631) 208-2900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140611001639 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9335030774 Receives reassigned benefits from 4 practitioners
Practice locations: Cutchogue, NY; Riverhead, NY

National Provider Directory

National Provider Directory

Locations

28000 Main Rd
Cutchogue, NY 11935
Phone (631) 724-3470

31 Main Rd
Ste 4
Riverhead, NY 11901
Phone (631) 208-2900

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972655041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2442",
            "city": "AQUEBOGUE",
            "state": "NY",
            "postal_code": "119312442",
            "telephone_number": "631-208-2900",
            "fax_number": "631-208-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 MAIN RD",
            "address_2": "SUITE 4",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119011953",
            "telephone_number": "631-208-2900",
            "fax_number": "631-208-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH FORK PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAHL",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "631-208-2900",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "019081-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverhead, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.