Individual provider Active NPI

Sridhar Yalamanchili, PT

  • Physical Therapist
  • River Edge, NJ
National Provider Identifier
1336372473
Registry record updated Aug 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01252300 Issued in NJ
Practice address
1176 Main St Apt 39
River Edge, NJ 07661-2595
Phone
(201) 742-5374
NPI assigned
Aug 24, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2018

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 40QA01252300 NJ Primary

Addresses

Primary practice location

1176 Main St Apt 39
River Edge, NJ 07661-2595

Mailing address

475 Prospect Ave
Ste 110
West Orange, NJ 07052-4197
Phone (201) 742-5374

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090918000415 NJ Practitioner - Physical Therapist in Private Practice 7810043676 Reassigns benefits to 2 organizations
I20250505002521 NY Practitioner - Physical Therapist in Private Practice 7810043676 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01252300NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Proform Physical Therapy LLC Physical Therapist CurrentSince Sep 30, 2024 Accepting new patients
Ignite Rehab Corp Physical Therapist CurrentSince Jan 14, 2024 Accepting new patients
At Home by Enhance Therapies LLC Physical Therapist CurrentSince Aug 23, 2022 Accepting new patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic Physical Therapist CurrentSince Apr 1, 2025 Accepting new patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic CurrentSince Apr 1, 2025 Accepting new patients
Proform Physical Therapy LLC Physical Therapist CurrentSince Sep 30, 2024 Accepting new patients
Sportsmed PT LLC Physical Therapist PastSince Nov 3, 2022 Accepting new patients

Locations

1003 Main Ave
Clifton, NJ 07011
Phone (201) 344-2499

411 Hackensack Ave
Ste 200
Hackensack, NJ 07601
Phone (732) 987-3833

400 Route 70
Lakewood, NJ 08701
Phone (732) 802-7512

1077 State Route 34
Ste M
Matawan, NJ 07747
Phone (732) 970-7882

210 N Central Ave
Ste 330
Hartsdale, NY 10530
Phone (914) 873-1878

972 Brush Hollow Rd
Westbury, NY 11590

Organizations & group practices 7

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": "1251072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535414400000",
    "number": "1336372473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 PROSPECT AVE",
            "address_2": "STE 110",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070524197",
            "telephone_number": "201-742-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1176 MAIN ST APT 39",
            "city": "RIVER EDGE",
            "state": "NJ",
            "postal_code": "076612595",
            "telephone_number": "201-742-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YALAMANCHILI",
        "first_name": "SRIDHAR",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-24",
        "last_updated": "2018-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01252300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in River Edge, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.