Individual provider Active NPI

Matthew John Triboletti, DPT

  • Physical Therapist
  • Hammonton, NJ
National Provider Identifier
1043635386
Registry record updated Jan 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01486300 Issued in NJ
Practice address
777 S White Horse Pike Ste D3
Hammonton, NJ 08037-2029
Phone
(609) 204-4621
NPI assigned
Feb 24, 2014
Last updated
Jan 20, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2021

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 40QA01486300 NJ Primary

Addresses

Primary practice location

777 S White Horse Pike Ste D3
Hammonton, NJ 08037-2029

Mailing address

777 S White Horse Pike Ste D3
Hammonton, NJ 08037-2029
Phone (609) 204-4621

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200611000266 NJ Practitioner - Physical Therapist in Private Practice 2567883929 Reassigns benefits to 2 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

Practice addresses (Care Compare)

777 S White Horse Pike
Suite D3
Hammonton, NJ 08037-2029
Phone (609) 481-2760

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01486300NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Chiropractic Associates PA CurrentSince Mar 4, 2021 Accepting new patients
Beyond Balance & Rehabilitation LLC Physical Therapist CurrentSince Apr 1, 2020 Accepting new patients

Locations

429 White Horse Pike
Atco, NJ 08004
Phone (856) 753-1111

777 S White Horse Pike
Ste D3
Hammonton, NJ 08037
Phone (609) 204-4621

Organizations & group practices 2

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": "1393200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1043635386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 S WHITE HORSE PIKE STE D3",
            "city": "HAMMONTON",
            "state": "NJ",
            "postal_code": "080372029",
            "telephone_number": "609-204-4621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 S WHITE HORSE PIKE STE D3",
            "city": "HAMMONTON",
            "state": "NJ",
            "postal_code": "080372029",
            "telephone_number": "609-204-4621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIBOLETTI",
        "first_name": "MATTHEW",
        "middle_name": "JOHN",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-02-24",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01486300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hammonton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; 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.