MR. JESUBIELIN CUSTODIO PERONILLA PT
NPI 1174338552
Physical Medicine & Rehabilitation in Astoria, NY

Active since February 11, 2025Accepts Medicare Assignment
3808 23RD AVE APT 1F, ASTORIA, NY 11105(347) 350-1235 Get Directions Write a Review

NPPES record last updated: February 11, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Mr. Jesubielin Custodio Peronilla Pt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JESUBIELIN CUSTODIO PERONILLA PT (NPI 1174338552) is an individual physical medicine & rehabilitation provider in Astoria, New York, licensed in New York (050395) and active in the NPI registry since February 2025. He is a graduate of Other (2015).

NPPES Registry Identity

NPI1174338552
Entity TypeIndividualMale
Primary Taxonomy208100000X
Provider Legal NameMR. JESUBIELIN CUSTODIO PERONILLACredential: PT
Location Address3808 23RD AVE APT 1FAstoria, NY 11105-1963
Mailing Address3808 23rd Ave Apt 1fAstoria, NY 11105-1963 · (347) 350-1235
Sole ProprietorYes
Medical School CMSOtherGraduated 2015
Enumeration DateFebruary 11, 2025
NPPES CertifiedFebruary 11, 2025
✔ NPI 1174338552 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysical Medicine & RehabilitationAllopathic & Osteopathic Physicians
Taxonomy Code208100000X
License✔ Licensed in NY · 050395
Definition
Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. These disabilities may arise from conditions affecting the musculoskeletal system such as neck and back pain, sports injuries, or other painful conditions affecting the limbs, such as carpal tunnel syndrome. Alternatively, the disabilities may result from neurological trauma or disease such as spinal cord injury, head injury or stroke. A physician certified in physical medicine and rehabilitation is often called a physiatrist. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation. Pain management is often an important part of the role of the physiatrist. For diagnosis and evaluation, a physiatrist may include the techniques of electromyography to supplement the standard history, physical, x-ray and laboratory examinations. The physiatrist has expertise in the appropriate use of therapeutic exercise, prosthetics (artificial limbs), orthotics and mechanical and electrical devices.
3808 23RD AVE APT 1F, Astoria, NY 11105

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Jesubielin Custodio Peronilla Pt is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7911425871
PECOS Enrollment IDI20250515000874

Medicare Billing Reassignments

2

Medicare enrollment records show Jesubielin Peronilla reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Physical Therapy
6805 FRESH POND RD
Ridgewood, NY 11385
  • Reassigned Medicare billing, New York enrollment
  • Medicare enrollment name: Fresh Pond Physical Therapy PC
  • 34 clinicians in this Medicare group
Physical Therapist
99 HUDSON ST FL 5
New York, NY 10013
  • Reassigned Medicare billing, New York enrollment
  • 364 clinicians in this Medicare group

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jesubielin Peronilla's NPI number?

The NPI number for Jesubielin Peronilla is 1174338552. It was assigned to this individual provider in the NPPES registry on February 11, 2025.

Where is Jesubielin Peronilla located?

Jesubielin Peronilla practices at 3808 23rd Ave Apt 1F, Astoria, NY 11105. The listed phone number is (347) 350-1235.

What is Jesubielin Peronilla's specialty?

The primary specialty registered for this NPI is Physical Medicine & Rehabilitation with taxonomy code 208100000X.

Is Jesubielin Peronilla enrolled in Medicare?

Yes. Jesubielin Peronilla is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Jesubielin Peronilla's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jesubielin Peronilla reassigns Medicare benefits to 2 organizations: Fresh Pond Physical Therapy, P.C (Ridgewood, NY) and Bienetre Medical PC (New York, NY). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jesubielin Peronilla's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jesubielin Peronilla was last updated on February 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.