Active NPI
Tyler Portelli, LMT
- Massage Therapist
- Ronkonkoma, NY
National Provider Identifier
1992389704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 029677
- Practice address
- 700 Union Pkwy
Ronkonkoma, NY 11779-7427 - Phone
- (516) 330-9817
- NPI assigned
- May 7, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 029677 | NY | Primary |
Addresses
Primary practice location
700 Union Pkwy
Ronkonkoma, NY 11779-7427
Mailing address
PO Box 997
Bethpage, NY 11714-0019
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029677 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620345600000",
"number": "1992389704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 997",
"city": "BETHPAGE",
"state": "NY",
"postal_code": "117140019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 UNION PKWY",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117797427",
"telephone_number": "516-330-9817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTELLI",
"first_name": "TYLER",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-07",
"last_updated": "2021-05-07",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "029677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ronkonkoma, NY
- Kristine Pohlmann
- Alex Mitchell Pollack, LMT
- Alexandra Pomatico, MA, CF-SLP, TSSLD
- Christine Ann Ponzio, MS ED
- Janine Joan Porco, R.N.
- Precision Imaging LLC
- Preferred Professional Medical Care PC
- Preferred Professional Medical Care PC
- Premier Home Health Care Services, Inc.
- Prime Diagnostic Imaging Corp.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.