NPIMap

Organization Active NPI

Dynamic Physical Therapy at Home

  • Physical Therapist
  • Northvale, NJ
National Provider Identifier
1396219044
Registry record updated Jan 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
DYNAMIC PHYSICAL THERAPY AT HOME
Practice address
220 Livingston St Ste 108
Northvale, NJ 07647-1739
Phone
(201) 564-7515
NPI assigned
Jan 16, 2019
Last updated
Jan 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2019

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

Authorized official

Name
Christopher MercadoNPI 1619024122
Title
Managing Director
Phone
(201) 564-7515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

220 Livingston St Ste 108
Northvale, NJ 07647-1739

Mailing address

220 Livingston St Ste 108
Northvale, NJ 07647-1739
Phone (201) 564-7515

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190404000438 NJ Part B Supplier - Clinic/Group Practice 9133460934 Receives reassigned benefits from 16 practitioners
Practice locations: Northvale, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547596800000",
    "number": "1396219044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 LIVINGSTON ST STE 108",
            "city": "NORTHVALE",
            "state": "NJ",
            "postal_code": "076471739",
            "telephone_number": "201-564-7515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 LIVINGSTON ST STE 108",
            "city": "NORTHVALE",
            "state": "NJ",
            "postal_code": "076471739",
            "telephone_number": "201-564-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PHYSICAL THERAPY AT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-16",
        "last_updated": "2019-01-16",
        "status": "A",
        "authorized_official_last_name": "MERCADO",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "201-564-7515"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northvale, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2019; 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.