EXECUTIVE PARK ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC
NPI 1649392283
Physical Therapist - Orthopedic in Yonkers, NY
About Executive Park Orthopedic & Sports Physical Therapy Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
EXECUTIVE PARK ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC (NPI 1649392283) is a healthcare organization registered as an orthopedic in Yonkers, New York and active in the NPI registry since April 2007. The organization lists Ivan Hernandez, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Executive Park Orthopedic & Sports Physical Therapy Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by January 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Executive Park Orthopedic & Sports Physical Therapy LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
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 Executive Park Orthopedic & Sports Physical Therapy LLC's NPI number?
The NPI number for Executive Park Orthopedic & Sports Physical Therapy LLC is 1649392283. It was assigned to this organization in the NPPES registry on April 4, 2007.
Where is Executive Park Orthopedic & Sports Physical Therapy LLC located?
Executive Park Orthopedic & Sports Physical Therapy LLC is located at 1034 N Broadway 2nd Floor, Yonkers, NY 10701. The listed phone number is (914) 509-4640.
What is Executive Park Orthopedic & Sports Physical Therapy LLC's specialty?
The primary specialty registered for this NPI is Physical Therapist, specializing in Orthopedic, with taxonomy code 2251X0800X.
Is Executive Park Orthopedic & Sports Physical Therapy LLC enrolled in Medicare?
Yes. Executive Park Orthopedic & Sports Physical Therapy LLC is registered in the Medicare PECOS enrollment system.
When is Executive Park Orthopedic & Sports Physical Therapy LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare DME enrollment for this organization (New York, Independently-Practicing Physical Therapist) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Executive Park Orthopedic & Sports Physical Therapy LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Physical Therapist in Private Practice, reassign their Medicare billing to Executive Park Orthopedic & Sports Physical Therapy LLC. A 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 the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Executive Park Orthopedic & Sports Physical Therapy LLC was last updated on April 23, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Executive Park Orthopedic & Sports Physical Therapy Llc · NPI 1649392283
Orthopedic organization in Yonkers, New York. Organization record, active in the CMS NPPES registry since April 4, 2007.
## Identity
- **NPI:** 1649392283 (Entity type: Organization)
- **Enumerated:** April 4, 2007
- **Primary specialty:** Physical Therapist - Orthopedic · taxonomy 2251X0800X
- **Organization subpart:** No
- **Authorized official:** Ivan Hernandez, PRESIDENT
## Practice location
- **Address:** 1034 N BROADWAY, 2ND FLOOR, Yonkers, NY 10701-1303
- **Phone:** (914) 509-4640 · **Fax:** (914) 509-4639
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** January 31, 2027 (DME, New York, Independently-Practicing Physical Therapist) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians (Physical Therapist in Private Practice) reassign Medicare billing to this organization (form CMS-855R); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 23, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1649392283) · Data from the CMS NPPES public registry.