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

Mr. Russell Taveras, PT

Individual provider Physical Therapist · NPI 1669587465

Mr. Russell Taveras, PT is a Physical Therapist in Private Practice in Patchogue, New York. Graduated from State University of New York at Stony Brook, School of Medicine in 2004, 22 years ago. Accepts Medicare assignment. Licensed in New York.

Years since qualifying
22
Trained at
State University of New York at Stony Brook, School of Medicine
Licensed in
NY
In the registry since
2006
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

79 E Main St
Patchogue, NY 11772-3101
Phone: (631) 289-0088
Fax: (631) 289-6177
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 0270991 (NY)

Record details

NPI number1669587465
Entity typeIndividual (Type 1)
GenderMale
Credentials PT
Sole proprietorNo
NPI enumeratedAugust 20, 2006
Last updated in NPPESMarch 7, 2012

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolSTATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
Graduated 2004 (22 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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