Individual provider Active NPI

Jesus Josef Tiamzon Cabitac Jr., PT

  • Physical Therapist
  • Massapequa, NY
National Provider Identifier
1972706018
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
023341 Issued in NY
Practice address
143 Massachusetts Ave
Massapequa, NY 11758-4111
Phone
(917) 916-6745
Fax
(516) 837-0882
NPI assigned
Jun 6, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 023341 NY Primary

Addresses

Primary practice location

143 Massachusetts Ave
Massapequa, NY 11758-4111

Mailing address

143 Massachusetts Ave
Massapequa, NY 11758-4111
Phone (917) 916-6745

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040624000545 NY Practitioner - Physical Therapist in Private Practice 8426034224 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
023341NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
J & N Rehab Physical Therapy PLLC Physical Therapist CurrentSince Sep 26, 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": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1972706018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 MASSACHUSETTS AVE",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117584111",
            "telephone_number": "917-916-6745",
            "fax_number": "516-837-0882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 MASSACHUSETTS AVE",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117584111",
            "telephone_number": "917-916-6745",
            "fax_number": "516-837-0882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CABITAC",
        "first_name": "JESUS JOSEF",
        "middle_name": "TIAMZON",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-06",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "023341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Massapequa, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; 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.