Individual provider Active NPI

Jerome W Yoo, PT

  • Physical Medicine & Rehabilitation Physician
  • Woodcliff Lake, NJ
National Provider Identifier
1215917547
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
40QA00983200 Issued in NJ
Practice address
123 Broadway
Woodcliff Lake, NJ 07677
Phone
(201) 746-9966
NPI assigned
Jan 20, 2006
Last updated
Dec 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 40QA00983200 NJ Primary

Addresses

Primary practice location

123 Broadway
Woodcliff Lake, NJ 07677

Mailing address

123 Broadway
Woodcliff Lake, NJ 07677-8038
Phone (201) 746-9966

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041116000103 NJ Practitioner - Physical Therapist in Private Practice 1557322732 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

8 Lackawanna PLZ
Suite a
Montclair, NJ 07042-3604

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Next Level Sports Physical Therapy, LLC CurrentSince Apr 21, 2017 Accepting new patients
Maven Northeast Bergen, LLC PastSince Aug 8, 2021 Accepting new patients
Peter Barnett & Howard J Phillips Past Accepting new patients
NL Rehab & Performance, LLC Physical Medicine & Rehabilitation Past Accepting new patients

Locations

123 Broadway
Woodcliff Lake, NJ 07677
Phone (201) 642-2503

123 Broadway
Ste 1
Woodcliff Lk, NJ 07677
Phone (201) 746-9966

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1215917547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 BROADWAY",
            "city": "WOODCLIFF LAKE",
            "state": "NJ",
            "postal_code": "076778038",
            "telephone_number": "201-746-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 BROADWAY",
            "city": "WOODCLIFF LAKE",
            "state": "NJ",
            "postal_code": "07677",
            "telephone_number": "201-746-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOO",
        "first_name": "JEROME",
        "middle_name": "W",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NJ",
            "license": "40QA00983200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodcliff Lake, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.