Individual provider Active NPI

Kristine P Pepino, P.T.

  • Physical Therapist
  • Randolph, NJ
National Provider Identifier
1114139433
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01039500 Issued in NJ
Practice address
588 Route 10 West
Randolph, NJ 07869
Phone
(973) 366-6615
Fax
(973) 366-9427
NPI assigned
May 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 40QA01039500 NJ Primary

Addresses

Primary practice location

588 Route 10 West
Randolph, NJ 07869

Mailing address

2832 Debra Way
Union, NJ 07083-4113
Phone (908) 688-9078

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040623001401 NJ Practitioner - Physical Therapist in Private Practice 1658356555 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Healthpro Heritage Rehab & Fitness, LLC Physical Therapist CurrentSince Mar 5, 2018 Accepting new patients
Excellent Homecare of NJ LLC Physical Therapist CurrentSince Mar 3, 2021 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Physical Therapist CurrentSince Mar 5, 2018 Accepting new patients
Randolph Rehabilitation Center Physical Therapist Past Accepting new patients
Monmouth Medical Association PC Physical Therapist Past Accepting new patients

Locations

307 International Cir
Ste 100
Hunt Valley, MD 21030
Phone (410) 606-7720

40 Galesi Dr
Ste 5B
Wayne, NJ 07470
Phone (973) 837-8722

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114139433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2832 DEBRA WAY",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070834113",
            "telephone_number": "908-688-9078",
            "fax_number": "973-366-9427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "588 ROUTE 10 WEST",
            "city": "RANDOLPH",
            "state": "NJ",
            "postal_code": "07869",
            "telephone_number": "973-366-6615",
            "fax_number": "973-366-9427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEPINO",
        "first_name": "KRISTINE",
        "middle_name": "P",
        "name_prefix": "Ms.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01039500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.