Individual provider Active NPI

Jamie L Desena, DPT

  • Physical Therapist
  • Sparta, NJ
National Provider Identifier
1003182932
Registry record updated Jan 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01437400 Issued in NM
Practice address
13A Main St
Suite 4
Sparta, NJ 07871-1941
Phone
(973) 726-7400
Fax
(973) 726-7440
NPI assigned
Mar 26, 2012
Last updated
Jan 12, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40QA01437400 NM Primary

Addresses

Primary practice location

13A Main St
Suite 4
Sparta, NJ 07871-1941

Mailing address

11 Eagle Rock Ave
Ste 201
East Hanover, NJ 07936-3167
Phone (973) 726-7400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120425000332 NJ Practitioner - Physical Therapist in Private Practice 3779745468 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Greenwood Ave
Montclair, NJ 07042-3649
Phone (973) 746-2424

3 Wing Dr
Suite 250
Cedar Knolls, NJ 07927-1018
Phone (862) 430-4099

301 S Livingston Ave
Suite 105
Livingston, NJ 07039-3929
Phone (862) 308-1144

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01437400NMMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Aug 12, 2024 Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist Current Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Aug 12, 2024 Accepting new patients

Locations

301 S Livingston Ave
Ste 105
Livingston, NJ 07039
Phone (862) 308-1144

1 Greenwood Ave
Montclair, NJ 07042
Phone (973) 746-2424

524 Williamstown Rd
Ste B1
Sicklerville, NJ 08081
Phone (856) 516-0591

576 Broadhollow Rd
Melville, NY 11747

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515715200000",
    "number": "1003182932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 EAGLE ROCK AVE",
            "address_2": "STE 201",
            "city": "EAST HANOVER",
            "state": "NJ",
            "postal_code": "079363167",
            "telephone_number": "973-726-7400",
            "fax_number": "973-726-7440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13A MAIN ST",
            "address_2": "SUITE 4",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078711941",
            "telephone_number": "973-726-7400",
            "fax_number": "973-726-7440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESENA",
        "first_name": "JAMIE",
        "middle_name": "L",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-26",
        "last_updated": "2018-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "40QA01437400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparta, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.