Evan Deckelbaum, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01592700 Issued in NJ

Practice address

1111 Clifton Ave
Clifton, NJ 07013-3633

Phone

(973) 400-3730

NPI assigned

Sep 18, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forward Motion Physical Therapy LLCGroup PAC ID 1355497116, 5 clinicians

Forward Motion PT LLCGroup PAC ID 8022350297, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Forward Motion Physical Therapy LLC

  • Physical Therapist
  • Clifton, NJ
  • NPI 1114157344
  Medicare reassignment Care Compare group NPD
• Forward Motion PT, LLC

  • Physical Therapy Clinic/Center
  • Pequannock, NJ
  • NPI 1568927028

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Ivyrehab Network Inc.

  • Physical Therapist
  • Hoboken, NJ
  • NPI 1174577274
  Medicare reassignment NPD
• Ivyrehab Network, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Cranford, NJ
  • NPI 1699590265

  Physical Therapist

  NPD

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

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427155200000",
    "number": "1356591986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 RAAB AVE",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070034520",
            "telephone_number": "410-382-4644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 CLIFTON AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070133633",
            "telephone_number": "973-400-3730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKELBAUM",
        "first_name": "EVAN",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-18",
        "last_updated": "2015-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "031521",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01592700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David A Debell
• Jason Deblinger, D.M.D.
• Ronald I. Deblinger, D.M.D.
• Alena Debrosse, NPP
• Diane Decarolis, NP
• Deep Venture Cap
• Michele Marie Degennaro
• Frank C Degiacomo
• Nicholas Degregorio, LMT
• Sandra H Deitch, CNM, NP

• Physical Therapist in Clifton, NJ
• Providers in Clifton, 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 Mar 24, 2015; 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.