Individual provider Active NPI

Robert Ackerly, PT

  • Physical Therapist
  • Syosset, NY
National Provider Identifier
1992774046
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
NY020526 Issued in NY
Practice address
54 Ira Rd
Syosset, NY 11791-3503
Phone
(516) 921-6464
Fax
(516) 921-7676
NPI assigned
Mar 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 NY020526 NY Primary

Addresses

Primary practice location

54 Ira Rd
Syosset, NY 11791-3503

Mailing address

54 Ira Rd
Syosset, NY 11791-3503
Phone (516) 921-6464

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040331000698 NY Practitioner - Physical Therapist in Private Practice 4284626284 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1 Albertson Ave
Albertson, NY 11507-1414
Phone (516) 277-2054

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
NY020526NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Core Motion PT, PLLC Physical Therapist CurrentSince Jul 1, 2015 Accepting new patients
Soma Fit Physical Therapy PLLC Physical Therapist PastSince Jun 1, 2007 Accepting new patients

Locations

1 Albertson Ave
Albertson, NY 11507
Phone (516) 277-2054

Organizations & group practices 2

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992774046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 IRA RD",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117913503",
            "telephone_number": "516-921-6464",
            "fax_number": "516-921-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 IRA RD",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117913503",
            "telephone_number": "516-921-6464",
            "fax_number": "516-921-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACKERLY",
        "first_name": "ROBERT",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "NY020526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syosset, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.