Mitchell Gordon Nielsen, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

40QB00295300 Issued in NJ

Practice address

573 Amboy Ave
Woodbridge, NJ 07095-3049

Phone

(908) 282-3737

NPI assigned

May 22, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Health & Fitness Professionals LLC

  • Sports Physical Therapist
  • Scotch Plains, NJ
  • NPI 1447628581
  NPD

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

{
    "created_epoch": "1590105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590105600000",
    "number": "1265055420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 HULSE AVE",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087241516",
            "telephone_number": "412-952-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "573 AMBOY AVE",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070953049",
            "telephone_number": "908-282-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "MITCHELL",
        "middle_name": "GORDON",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-22",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NJ",
            "license": "40QB00295300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriel Anthony Navedo
• Norman Nepo, DDS
• New Jersey CVS Pharmacy LLC
• Nextmove Associates LLC
• Tasheea T Nicholson
• Meena Nihalani, M.D.
• NJ Orthopedic Rehab and Pain Management Group PC
• NJ Response Training & Consulting LLC
• Welena Noel, LSW,MSW
• Michelle Maria Nolasco

• Physical Therapy Assistant in Woodbridge, NJ
• Providers in Woodbridge, NJ by specialty
• Physical Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.