Individual provider Active NPI

Jenna Eoga, PT, DPT

  • Physical Therapist
  • Sparta, NJ
National Provider Identifier
1376373241
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA02268700 Issued in NJ
Practice address
243 Sparta Ave Ste 2
Sparta, NJ 07871-1143
Phone
(973) 512-3180
NPI assigned
Aug 6, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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 40QA02268700 NJ Primary

Addresses

Primary practice location

243 Sparta Ave Ste 2
Sparta, NJ 07871-1143

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224
Phone (914) 294-4050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240920000875 NJ Practitioner - Physical Therapist in Private Practice 1759822588 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Network IncGroup PAC ID 3476539776, 658 clinicians

Practice addresses (Care Compare)

243 Sparta Ave
Suite 2
Sparta, NJ 07871-1143
Phone (973) 512-3180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA02268700NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Network Inc. Physical Therapist Current Accepting new patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Sep 1, 2024 Accepting new patients
Ivyrehab Network Inc Physical Therapist CurrentSince Sep 1, 2024 Accepting new patients

Locations

731 Lacey Rd
Ste 3
Forked River, NJ 08731
Phone (609) 242-6780

454 Passaic St
Hackensack, NJ 07601
Phone (201) 488-7905

243 Sparta Ave
Ste 2
Sparta, NJ 07871
Phone (973) 512-3180

376 Lafayette Rd
Ste 105
Sparta, NJ 07871
Phone (862) 343-6727

1311 Mamaroneck Ave
Ste 140
White Plains, NY 10605
Phone (914) 265-4838

Organizations & group practices 3

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": "1722902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1376373241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 SPARTA AVE STE 2",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078711143",
            "telephone_number": "973-512-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EOGA",
        "first_name": "JENNA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02268700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparta, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.