Professional Occupational & Physical Therapy, PLLC
Organization Active NPI Occupational Therapist · Randolph, NJ
NPI 1104376680 · NPPES record last updated Apr 23, 2019
Key facts
- NPI
- 1104376680
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Occupational Therapist 225X00000X
- Legal business name
- PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC
- Practice address
- 390 State Route 10 Ste 202
Randolph, NJ 07869-2141 - Phone
- (973) 895-9925
- Fax
- (973) 895-9927
- NPI assigned
- Oct 10, 2016
- Organization subpart
- No
Authorized official
- Name
- Kathllen Brush
- Title
- Credentialing Manager
- Phone
- (631) 359-5859
Member of 1
Practitioners 802
-
Kimberly Afordakos, DPT
-
Nicole Antista, PT, DPT
-
Christian Atexide, D.P.T
-
Gabriel Barbosa, DPT
-
Anna Elizabeth Becker, OTR/L
-
Brian Brateris, DPT
-
Ryan Breznovits, PT, DPT
-
Susan Breznovits, PT, DPT
-
Alesandro Bua, PT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170118000654 | NJ | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 3779873401 |
Receives reassigned benefits from 296 practitioners This NPI is an additional NPI on the enrollment |
| O20260116002957 | NJ | DME Supplier - Independently-Practicing Occupational Therapist |
3779873401 | Practice locations: Randolph, NJ |
National Provider Directory
Locations (25 of 51)
53 Old Kings Hwy N
Ste 103
Darien, CT 06820
Phone (203) 656-1922
37 Danbury Rd
Wilton, CT 06897
Phone (203) 762-2900
150 Morristown Rd
Ste 110
Bernardsville, NJ 07924
Phone (908) 766-1700
31 Broad St
Bloomfield, NJ 07003
Phone (631) 359-5800
14 Ridgedale Ave
Ste 104
Cedar Knolls, NJ 07927
Phone (862) 430-4099
3 Wing Dr
Ste 250
Cedar Knolls, NJ 07927
Phone (862) 430-4099
484 Southern Blvd
Chatham, NJ 07928
Phone (973) 377-5990
1255 Broad St
#2
Clifton, NJ 07013
Phone (973) 947-8739
300 Knickerbocker Rd
Ste 1600
Cresskill, NJ 07626
64 River Rd
East Hanover, NJ 07936
Phone (973) 428-1050
2035 Lincoln Hwy
Ste 1040
Edison, NJ 08817
Phone (732) 702-1099
619 River Dr
Fl 330
Elmwood Park, NJ 07407
Phone (201) 712-5533
440 Old Hook Rd
Fl 1
Emerson, NJ 07630
Phone (201) 497-6752
77 Schanck Rd
Ste C3
Freehold, NJ 07728
Phone (732) 414-2490
201 Rock Rd
Fl 1
Glen Rock, NJ 07452
Phone (551) 276-6624
5 Marine View Plz
Ste 405
Hoboken, NJ 07030
Phone (201) 683-8058
240 W Passaic St
Ste 12
Maywood, NJ 07607
Phone (551) 245-8282
1 Greenwood Ave
Montclair, NJ 07042
Phone (973) 746-2424
33 Georges Rd
Ste 104
New Brunswick, NJ 08901
Phone (732) 712-2912
222 High St
Ste 203
Newton, NJ 07860
Phone (973) 383-3822
45 Franklin Ave
Nutley, NJ 07110
Phone (973) 235-0500
281 Witherspoon St
Ste 201
Princeton, NJ 08540
Phone (609) 279-2194
390 State Route 10
Ste 202
Randolph, NJ 07869
Phone (973) 895-9925
1325 Warren Ave
Ste 5
Spring Lake, NJ 07762
Phone (732) 449-7855
20 Commerce Blvd
Ste B
Succasunna, NJ 07876
Phone (862) 683-1001
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | |||
| Occupational Therapist |
225X00000X | Yes |
Addresses
Primary practice location
390 State Route 10 Ste 202
Randolph, NJ 07869-2141
Mailing address
576 Broadhollow Rd
Melville, NY 11747-5002
Phone (631) 359-5859
Other providers in Randolph, NJ
- Tara Christine Plansky
- Prasada Center for Wellbeing East
- Prasada Center for Wellbeing Inc
- Prime Healthcare Services - Saint Clare'S, LLC
- Pro Physical Therapy, LLC
- Professional Orthopedic and Sports Physical Therapy of N.J., L.L.C.
- Professional Portable Radiologic Services, Inc.
- Derek Protasiewicz
- Edit Punk
- Joseph Vito Racanelli
All providers in Randolph, NJ · Occupational Therapist in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.