Active NPI
Raymond Fung, M.P.T.
- Physical Therapist
- Fort Lee, NJ
National Provider Identifier
1174773626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA01332900
- Practice address
- 1355 15TH Street
Fort Lee, NJ 07024 - Phone
- (201) 224-8717
- Fax
- (201) 224-6381
- NPI assigned
- Sep 22, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 18083 | MA | |
| Physical Therapist | 225100000X | 40QA01332900 | NJ | Primary |
Addresses
Primary practice location
1355 15TH Street
Fort Lee, NJ 07024
Mailing address
605 Main Street
Hackensack, NJ 07601
Phone (201) 488-0488
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40QA01332900 | Other | NJ | PT LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18083 | MA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257724800000",
"number": "1174773626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "605 MAIN STREET",
"city": "HACKENSACK",
"state": "NJ",
"postal_code": "07601",
"telephone_number": "201-488-0488",
"fax_number": "201-343-5325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1355 15TH STREET",
"city": "FORT LEE",
"state": "NJ",
"postal_code": "07024",
"telephone_number": "201-224-8717",
"fax_number": "201-224-6381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNG",
"first_name": "RAYMOND",
"credential": "M.P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-22",
"last_updated": "2009-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "18083",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA01332900",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE",
"identifier": "40QA01332900",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Lee, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.