Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Central Park Physical Medicine PC

Organization Specialist · NPI 1174848501

Central Park Physical Medicine PC is a Specialist in Laurelton, New York. Licensed in New York. Registered with an NPI since 2010.

Licensed in
NY
In the registry since
2010
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

21714 Merrick Blvd
Laurelton, NY 11413-1917
Phone: (347) 270-8353
Fax: (347) 826-1917
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 194218-1 (NY)

Record details

NPI number1174848501
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Samuel Theagene — Owner · (347) 270-8353
NPI enumeratedMarch 29, 2010
Last updated in NPPESMarch 30, 2015
Mailing address21714 Merrick Blvd, Laurelton, NY 11413-1917

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