Individual provider Active NPI

Brian Tababa, PT, DPT

  • Physical Therapist
  • Union, NJ
National Provider Identifier
1275076366
Registry record updated Nov 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01705000 Issued in NJ
Practice address
1025 Harding Ave
Union, NJ 07083-6116
Phone
(908) 463-0966
NPI assigned
Nov 22, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40QA01705000 NJ Primary

Addresses

Primary practice location

1025 Harding Ave
Union, NJ 07083-6116

Mailing address

1025 Harding Ave
Union, NJ 07083-6116
Phone (908) 463-0966

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170118000130 NJ Practitioner - Physical Therapist in Private Practice 8527340017 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Network IncGroup PAC ID 3476539776, 658 clinicians
Life Home Therapy LLCGroup PAC ID 1254746340, 50 clinicians

Practice addresses (Care Compare)

1111 US Hwy 22
Mountainside, NJ 07092-2814
Phone (908) 389-9100

70 S Orange Ave
Suite 220
Livingston, NJ 07039-4920
Phone (917) 751-8706

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01705000NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Feb 1, 2026 Accepting new patients
Life Home Therapy LLC Physical Therapist CurrentSince Feb 1, 2023 Accepting new patients
Ivyrehab Network Inc Physical Therapist CurrentSince Feb 1, 2026 Accepting new patients
Jag-One Physical Therapy, LLC Physical Therapist CurrentSince Jul 12, 2023 Accepting new patients

Locations

981 US Highway 22
Fl 2
Bridgewater, NJ 08807
Phone (908) 231-0511

3830 Park Ave
Ste 202
Edison, NJ 08820
Phone (732) 494-0895

300 South Ave
Ste 14
Garwood, NJ 07027
Phone (908) 232-4888

454 Passaic St
Hackensack, NJ 07601
Phone (201) 488-7905

2107 State Route 35
Holmdel, NJ 07733
Phone (732) 587-5065

70 S Orange Ave
Ste 220
Livingston, NJ 07039
Phone (973) 626-2350

1111 US Highway 22
Mountainside, NJ 07092
Phone (908) 389-9100

221 Rockingham Row
Princeton, NJ 08540
Phone (609) 580-1520

2360 Morris Ave
Union, NJ 07083
Phone (908) 206-1700

622 Eagle Rock Ave
West Orange, NJ 07052
Phone (973) 669-0078

453 Amboy Ave
Woodbridge, NJ 07095
Phone (732) 388-4184

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479772800000",
    "number": "1275076366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 HARDING AVE",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070836116",
            "telephone_number": "908-463-0966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 HARDING AVE",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070836116",
            "telephone_number": "908-463-0966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABABA",
        "first_name": "BRIAN",
        "name_prefix": "Mr.",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-22",
        "last_updated": "2016-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01705000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2016; 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.