NPIMap

Organization Active NPI

Optimal Form & Function, LLC

  • Physical Therapist
  • Teaneck, NJ
National Provider Identifier
1194402180
Registry record updated Dec 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
OPTIMAL FORM & FUNCTION, LLC
Practice address
1029 Teaneck Rd Ste 2E
Teaneck, NJ 07666-4514
Phone
(551) 246-9340
NPI assigned
Jun 30, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2023

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

Authorized official

Name
Dr. Michael Formisano, PT, DPT, OCSNPI 1902029242
Title
Founder/Physical Therapist
Phone
(201) 817-9976

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Hand Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XH1200X

Addresses

Primary practice location

1029 Teaneck Rd Ste 2E
Teaneck, NJ 07666-4514

Mailing address

3-18 Virginia Dr Apt a
Fair Lawn, NJ 07410-4727
Phone (201) 887-2409

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231127000578 NJ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8123476553 Receives reassigned benefits from 1 practitioner
Practice locations: Teaneck, NJ

National Provider Directory

National Provider Directory
Tax ID family
Optimal Form Function LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702684800000",
    "number": "1194402180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3-18 VIRGINIA DR APT A",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074104727",
            "telephone_number": "201-887-2409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 TEANECK RD STE 2E",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664514",
            "telephone_number": "551-246-9340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL FORM & FUNCTION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-12-16",
        "certification_date": "2023-12-16",
        "status": "A",
        "authorized_official_last_name": "FORMISANO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "FOUNDER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "201-817-9976",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Hand",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Teaneck, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2023; 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.