1. Home
  2. Directory
  3. New York
  4. Laurelton
  5. Specialist
  6. NPI Profile

CENTRAL PARK PHYSICAL MEDICINE PC
NPI 1174848501
Specialist in Laurelton, NY

Active since March 29, 2010
21714 MERRICK BLVD, LAURELTON, NY 11413(347) 270-8353(347) 826-1917 Get Directions Write a Review

NPPES record last updated: March 30, 2015. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Central Park Physical Medicine Pc NPPES

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

CENTRAL PARK PHYSICAL MEDICINE PC (NPI 1174848501) is a healthcare organization registered as a specialist in Laurelton, New York and active in the NPI registry since March 2010. The organization lists Samuel Michael Theagene, Owner, as its authorized official.

NPPES Registry Identity

NPI1174848501
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameCENTRAL PARK PHYSICAL MEDICINE PC
Location Address21714 MERRICK BLVDLaurelton, NY 11413-1917
Mailing Address21714 Merrick BlvdLaurelton, NY 11413-1917 · (347) 270-8353 · Fax (347) 826-1917
Phone(347) 270-8353
Fax(347) 826-1917
Organization SubpartNo
Authorized OfficialSamuel Michael TheageneOwner · (347) 270-8353
Enumeration DateMarch 29, 2010
Last NPPES UpdateMarch 30, 2015
✔ NPI 1174848501 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in NY · 194218-1
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
21714 MERRICK BLVD, Laurelton, NY 11413
Open in Google Maps ↗

Other Identifiers 1

Other194218-1NY · State Of Ny Education Dept

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. TRISILYN VIRADOR SUMAMPONG PT
Physical Therapist
21714 MERRICK BLVD
LAURELTON, NY 11413
Queens County (347) 270-8353
SAMUEL OKONTA MD
Emergency Medicine
21714 MERRICK BLVD
LAURELTON, NY 11413
Queens County (718) 712-1428
ANCHOR OPTOMETRIC CARE PC
Optometrist
21714 MERRICK BLVD
LAURELTON, NY 11413
Queens County (718) 978-0100

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 Central Park Physical Medicine PC's NPI number?

The NPI number for Central Park Physical Medicine PC is 1174848501. It was assigned to this organization in the NPPES registry on March 29, 2010.

Where is Central Park Physical Medicine PC located?

Central Park Physical Medicine PC is located at 21714 Merrick Blvd, Laurelton, NY 11413. The listed phone number is (347) 270-8353.

What is Central Park Physical Medicine PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Central Park Physical Medicine PC was last updated on March 30, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years 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.