Michael Ryan Blanco, DPT
Individual provider Active NPI Physical Therapist · Closter, NJ
NPI 1104553262 · NPPES record last updated Aug 8, 2022
Key facts
- NPI
- 1104553262
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 40QA02105400 (NJ)
- Practice address
- 31 Ver Valen St
Closter, NJ 07624-2699 - Phone
- (201) 784-2700
- NPI assigned
- Aug 8, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221104000578 | NJ | Practitioner - Physical Therapist in Private Practice | 8527435544 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QA02105400 | NJ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spine and Health Center of Closter PC | Physical Therapist | Current |
Accepting new patients |
| The Spine and Health Center of Montvale | Physical Therapist | Current |
Accepting new patients |
Locations
31 Ver Valen St
Closter, NJ 07624
Phone (201) 784-2700
32 Philips Pkwy
Montvale, NJ 07645
Phone (201) 494-4479
2 S Kinderkamack Rd
Ste 208
Montvale, NJ 07645
Phone (201) 746-6577
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 40QA02105400 | NJ | Yes |
Addresses
Primary practice location
31 Ver Valen St
Closter, NJ 07624-2699
Mailing address
5 Austin PL
Hasbrouck Heights, NJ 07604-1438
Phone (201) 220-9049
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40QA02105400 | Other | NJ | NEW JERSEY DIVISION OF CONSUMER AFFAIRS |
Other providers in Closter, NJ
- Norman G Bartner
- Bergen Healthcare LLC
- Bergen Home Care LLC
- Bergen Orthodontic Assoc., PA
- Bergen Orthopaedic Surgery & Sports Medicine
- Mona Teresa Lynch Boland
- Kelly Ann Braun
- David Christopher Buckner
- Magdealena Buczek
- Jonathan S Byrne
All providers in Closter, NJ · Physical 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 Aug 8, 2022. 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.