NPIMap

Organization Active NPI

Woodbury Physical Medicine, LLC

  • Chiropractor
  • Woodbury, NJ
National Provider Identifier
1053354878
Registry record updated Dec 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
38MC00365600 Issued in NJ
Legal business name
WOODBURY PHYSICAL MEDICINE, LLC
Practice address
223 S Evergreen Ave
Woodbury, NJ 08096-2713
Phone
(856) 848-1515
Fax
(856) 845-7753
NPI assigned
Jun 13, 2006
Last updated
Dec 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2012

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

Authorized official

Name
Dr. Guy David Pistilli, D.C.NPI 1669525598
Title
Manager
Phone
(856) 848-1515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 38MC00365600 NJ Primary
Physical Medicine & Rehabilitation Physician 208100000X 25MA03618000 NJ
Physical Therapist 225100000X 40QA00966600 NJ

Addresses

Primary practice location

223 S Evergreen Ave
Woodbury, NJ 08096-2713

Mailing address

223 South Evergreen Avenue
Woodbury, NJ 08096-2713
Phone (856) 848-1515

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355875200000",
    "number": "1053354878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 SOUTH EVERGREEN AVENUE",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080962713",
            "telephone_number": "856-848-1515",
            "fax_number": "856-845-7753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 S EVERGREEN AVE",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080962713",
            "telephone_number": "856-848-1515",
            "fax_number": "856-845-7753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBURY PHYSICAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2012-12-19",
        "status": "A",
        "authorized_official_last_name": "PISTILLI",
        "authorized_official_first_name": "GUY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "856-848-1515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00365600",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NJ",
            "license": "25MA03618000",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00966600",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.