John Anthony Gallucci Jr., MS, ATC, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01172700 Issued in NJ

Practice address

622 Eagle Rock Ave
West Orange, NJ 07052-2994

Phone

(973) 669-0078

Fax

(973) 669-1113

NPI assigned

Nov 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ, NY, PA3 enrollments

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Jag-One Physical Therapy, LLC

  • Physical Therapist
  • West Orange, NJ
  • NPI 1518017144
  Medicare reassignment Authorized official
• Bucks Physical & Sports Rehabilitation LLC

  • Physical Therapist
  • Richboro, PA
  • NPI 1932179215
  Medicare reassignment NPD
• RB Physical and Occupational Therapy PLLC

  • Physical Therapist
  • Brooklyn, NY
  • NPI 1790013282
  NPD (past)

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389744000000",
    "number": "1346314093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 EAGLE ROCK AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522994",
            "telephone_number": "973-669-0078",
            "fax_number": "973-669-1113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 EAGLE ROCK AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522994",
            "telephone_number": "973-669-0078",
            "fax_number": "973-669-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLUCCI",
        "first_name": "JOHN",
        "middle_name": "ANTHONY",
        "name_suffix": "Jr.",
        "credential": "MS, ATC, PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2014-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01172700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY  PHYSICAL THERAPY LICENSE",
            "identifier": "027198-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christodoulos A Fysentzou, PT
• G&M Therapy Group LLC
• Romina F Gadea
• Carly Galanaugh
• Louis C Galdieri, MD
• Albert Gambale, PT, DPT
• Maria Villette Ganancial, APN
• Manickam Ganesh, MD
• Abigail Grace Ganley
• Bruce Merrill Gans, MD

• Physical Therapist in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; 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.