Individual provider Active NPI

Andres Chacon

  • Physical Therapist
  • Lyndhurst, NJ
National Provider Identifier
1366074148
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01903000 Issued in NJ
Practice address
70 Ridge Rd
Lyndhurst, NJ 07071-1216
Phone
(201) 933-9959
Fax
(201) 933-9958
NPI assigned
Feb 10, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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 40QA01903000 NJ Primary

Addresses

Primary practice location

70 Ridge Rd
Lyndhurst, NJ 07071-1216

Mailing address

576 Broadhollow Rd
Melville, NY 11747-5002
Phone (631) 359-5859

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Rothman Orthopaedics of New Jersey, LLC CurrentSince Nov 1, 2020 Accepting new patients
Pro Staff Physical Therapy PC Physical Therapist CurrentSince Sep 12, 2022 Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Feb 26, 2020 Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist Current Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Feb 26, 2020 Accepting new patients
Rothman Institute of New Jersey, P.a. CurrentSince Nov 1, 2020 Accepting new patients
M&Ntherapyllc Physical Therapist CurrentSince May 9, 2022 Accepting new patients

Locations

935 Allwood Rd
Fl First
Clifton, NJ 07012
Phone (973) 928-3590

206 Bergen Ave
Fl 2
Kearny, NJ 07032
Phone (551) 580-7881

70 Ridge Rd
Lyndhurst, NJ 07071
Phone (201) 933-4775

999 Route 73 N
Ste 401
Marlton, NJ 08053

1 Greenwood Ave
Montclair, NJ 07042
Phone (973) 746-2424

265 Franklin Ave
Nutley, NJ 07110
Phone (973) 661-0500

524 Williamstown Rd
Ste B1
Sicklerville, NJ 08081
Phone (856) 516-0591

405 Northfield Ave
Ste Ll
West Orange, NJ 07052
Phone (973) 731-1950

576 Broadhollow Rd
Melville, NY 11747

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": "1581292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1366074148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 BROADHOLLOW RD",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117475002",
            "telephone_number": "631-359-5859",
            "fax_number": "631-396-0864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 RIDGE RD",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070711216",
            "telephone_number": "201-933-9959",
            "fax_number": "201-933-9958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACON",
        "first_name": "ANDRES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-10",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01903000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lyndhurst, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.