OrganizationActiveAccepts Medicare
Central Park Physical Medicine PC
NPI 1174848501 · Specialist · Laurelton, NY
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1174848501
- Entity type
- Organization
- Primary specialty
- SpecialistOther Service Providers
- Organization subpart
- No
- Authorized official
- Samuel Theagene, Owner(347) 270-8353
- License
- 194218-1 (NY)
Specialties & taxonomies
Other Service Providers
Profile Score
Detailed profile(84/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
21714 Merrick Blvd
Laurelton, NY 11413-1917
Phone: (347) 270-8353
Fax: (347) 826-1917
Street-level locationGet directions
Mailing address
21714 Merrick Blvd
Laurelton, NY 11413-1917
Registry dates
- Enumerated
- 2010-03-29
- Last updated
- 2015-03-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.