Brian Boland

Key facts

NPI

1114563269

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

40QA01904600 (NJ)

Practice address

615 Goodmans Xing
Clark, NJ 07066-2738

Phone

(732) 259-9468

NPI assigned

Nov 25, 2019

Sex

Male

Sole proprietor

Yes

Organizations & group practices 3

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.

• Ferris Home Rehabilitation LLC Physical Therapist · Clark, NJ · NPI 1831978600
  Medicare reassignment NPD Authorized official MULTI-SPECIALTY · NJ
• Coastal Home Rehabilitation, LLC Multi-Specialty Clinic/Center · Belmar, NJ · NPI 1316236664
  Medicare reassignment NPD MULTI-SPECIALTY · NJ
• Mobile Therapy Services, Inc. Physical Therapist · Ocean, NJ · NPI 1326495615
  Medicare reassignment NPD MULTI-SPECIALTY · NJ

Medicare participation

Medicare fee-for-service enrollment

Enrolled in NJ

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 21, 2023.

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1114563269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 GOODMANS XING",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070662738",
            "telephone_number": "732-259-9468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 GOODMANS XING",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070662738",
            "telephone_number": "732-259-9468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAND",
        "first_name": "BRIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-25",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01904600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clark, NJ

• Blossom Therapy and Wellness
• Bluefern Home Care LLC
• Richard Howard Blum, M.D.
• Lawrence J Bock, PT
• Faye Bodenstein, ACSW
• Gary I. Borker, D.M.D.
• Stephen D Bosonac, DDS
• Samuel Fares Samuel Botros
• Brandon Macy
• Ian Alfonzo Brewer, DC

All providers in Clark, NJ · Physical Therapist in New Jersey