Individual provider Active NPI

Mohamed Wyell Tarakji, PT, DPT

  • Physical Therapist
  • Newton, NJ
National Provider Identifier
1124852496
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA02284500 Issued in NJ
Practice address
280 Newton Sparta Rd Ste 8
Newton, NJ 07860-2775
Phone
(973) 494-7774
NPI assigned
Aug 29, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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 40QA02284500 NJ Primary

Addresses

Primary practice location

280 Newton Sparta Rd Ste 8
Newton, NJ 07860-2775

Mailing address

10 Netcong HTS Apt 6
Netcong, NJ 07857-1710
Phone (973) 580-8643

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240912003696 NJ Practitioner - Physical Therapist in Private Practice 3375083637 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Network IncGroup PAC ID 3476539776, 658 clinicians

Practice addresses (Care Compare)

80 Mill St
Suite 1
Newton, NJ 07860-1411
Phone (973) 940-7311

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA02284500NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Network Inc. Physical Therapist Current Accepting new patients
Ivyrehab Network Inc Physical Therapist CurrentSince Sep 3, 2024 Accepting new patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Sep 3, 2024 Accepting new patients
Melip Enterprises Physical Therapist CurrentSince Jan 6, 2025 Accepting new patients

Locations

731 Lacey Rd
Ste 3
Forked River, NJ 08731
Phone (609) 242-6780

454 Passaic St
Hackensack, NJ 07601
Phone (201) 488-7905

80 Mill St
#1
Newton, NJ 07860
Phone (973) 940-7311

280 Newton Sparta Rd
Ste 8
Newton, NJ 07860
Phone (973) 579-2957

104 Main St
Ste 1A
Sparta, NJ 07871
Phone (973) 729-1222

Organizations & group practices 4

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": "1724889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1124852496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 NETCONG HTS APT 6",
            "city": "NETCONG",
            "state": "NJ",
            "postal_code": "078571710",
            "telephone_number": "973-580-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 NEWTON SPARTA RD STE 8",
            "city": "NEWTON",
            "state": "NJ",
            "postal_code": "078602775",
            "telephone_number": "973-494-7774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARAKJI",
        "first_name": "MOHAMED",
        "middle_name": "WYELL",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-29",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02284500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.