Individual provider Active NPI

Jijo M John, PT

  • Physical Therapist
  • Yonkers, NY
National Provider Identifier
1396019519
Registry record updated Apr 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
034746 Issued in NY
Practice address
340 S Broadway
Yonkers, NY 10705-2049
Phone
(914) 968-5125
Fax
(914) 968-5123
NPI assigned
Mar 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2016

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 034746 NY Primary

Addresses

Primary practice location

340 S Broadway
Yonkers, NY 10705-2049

Mailing address

174 Grand St
White Plains, NY 10601-4803
Phone (914) 328-8077

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120621000164 NY Practitioner - Physical Therapist in Private Practice 7911161062 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
034746NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Doctors United, Inc CurrentSince Mar 5, 2012 Accepting new patients

Locations

1 Bridge St
Ardsley, NY 10502
Phone (914) 693-8782

741 E 233rd St
Bronx, NY 10466
Phone (718) 405-0205

174 Grand St
White Plains, NY 10601
Phone (718) 220-8293

176 Grand St
White Plains, NY 10601
Phone (914) 328-6080

340 S Broadway
Yonkers, NY 10705
Phone (914) 968-5125

Organizations & group practices 1

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": "1330992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460505600000",
    "number": "1396019519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 GRAND ST",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106014803",
            "telephone_number": "914-328-8077",
            "fax_number": "914-328-6079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 S BROADWAY",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107052049",
            "telephone_number": "914-968-5125",
            "fax_number": "914-968-5123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "JIJO",
        "middle_name": "M",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-06",
        "last_updated": "2016-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "034746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yonkers, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2016; 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.