NPIMap

Organization Active NPI

Prime Health Physical Therapy

  • Physical Therapy Clinic/Center
  • Linden, NJ
National Provider Identifier
1104891720
Registry record updated Oct 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PRIME HEALTH PHYSICAL THERAPY
Practice address
822 N Wood Ave
Suite 3
Linden, NJ 07036-4038
Phone
(908) 925-9700
Fax
(908) 663-2551
NPI assigned
Feb 17, 2006
Last updated
Oct 29, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2015

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

Authorized official

Name
Dr. Shawn A Davis, DPTNPI 1265429393
Title
Director
Phone
(908) 925-9700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

822 N Wood Ave
Suite 3
Linden, NJ 07036-4038

Mailing address

822 N Wood Ave
Suite 3
Linden, NJ 07036-4038
Phone (908) 925-9700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040202000279 NJ Part B Supplier - Clinic/Group Practice 3678476066 Receives reassigned benefits from 5 practitioners
Practice locations: Linden, NJ; Metuchen, NJ

National Provider Directory

National Provider Directory

Locations

822 N Wood Ave
Ste 3
Linden, NJ 07036
Phone (908) 925-9100

822 N Wood Ave
Ste C3
Linden, NJ 07036
Phone (908) 925-9700

Practitioners & affiliated clinicians

Practitioners 11

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": "1140134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446076800000",
    "number": "1104891720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "822 N WOOD AVE",
            "address_2": "SUITE 3",
            "city": "LINDEN",
            "state": "NJ",
            "postal_code": "070364038",
            "telephone_number": "908-925-9700",
            "fax_number": "908-663-2551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 N WOOD AVE",
            "address_2": "SUITE 3",
            "city": "LINDEN",
            "state": "NJ",
            "postal_code": "070364038",
            "telephone_number": "908-925-9700",
            "fax_number": "908-663-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTH PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-17",
        "last_updated": "2015-10-29",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "908-925-9700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Linden, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.