Selorm Takyi, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

25MA10560400 Issued in NJ

Practice address

1001 Lincoln Dr W Ste E
Marlton, NJ 08053-1534

Phone

(856) 983-9001

Fax

(856) 983-9011

NPI assigned

Apr 21, 2015

Last updated

Aug 27, 2020By the provider in NPPES

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

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HIBECD/Endpoint/HIBECD

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.

• Ascension Spine, Pain, and Sports Medicine

  • Interventional Pain Medicine Physician
  • East Brunswick, NJ
  • NPI 1124948856

  Physical Medicine & Rehabilitation

  NPD (past)
• Revive Spine and Pain Center

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Marlton, NJ
  • NPI 1457896003
  NPD (past)

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1316334998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "197 RIDGEDALE AVE STE 210",
            "city": "CEDAR KNOLLS",
            "state": "NJ",
            "postal_code": "079272111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 LINCOLN DR W STE E",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080531534",
            "telephone_number": "856-983-9001",
            "fax_number": "856-983-9011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKYI",
        "first_name": "SELORM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-21",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NJ",
            "license": "25MA10560400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carly Taglienti, CARLY
• Naa Ameley Tagoe, M.S, BCBA
• Stephen Tai, MD
• Take Control Mental Health Solutions
• Emily Takhtarov
• Jean Tama, CRNA
• Kasey Alexis Tankelewicz, CRNP
• Tao Clinic of Acupuncture
• Tao Integrative Medicine
• Marisa Nicole Tate, OTR/L

• Physical Medicine & Rehabilitation Physician in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Physical Medicine & Rehabilitation Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.