Active NPI
Modesta Angela Gamo Dumalag, PT
- Physical Therapist
- Cedar Grove, NJ
National Provider Identifier
1245445352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA01172300
- Practice address
- 536 Ridge Rd
Cedar Grove, NJ 07009-1611 - Phone
- (973) 239-9300
- NPI assigned
- May 11, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 40QA01172300 | NJ | Primary |
Addresses
Primary practice location
536 Ridge Rd
Cedar Grove, NJ 07009-1611
Mailing address
11 N Christie St
Bergenfield, NJ 07621-2202
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QA01172300 | NJ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245445352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 N CHRISTIE ST",
"city": "BERGENFIELD",
"state": "NJ",
"postal_code": "076212202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "536 RIDGE RD",
"city": "CEDAR GROVE",
"state": "NJ",
"postal_code": "070091611",
"telephone_number": "973-239-9300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUMALAG",
"first_name": "MODESTA ANGELA",
"middle_name": "GAMO",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA01172300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cedar Grove, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.