Tom R Willemann, PT,OCS,MS

Primary specialty

SpecialistTaxonomy code 174400000X

License

QA 007709 Issued in NJ

Practice address

541 Cedar Hill Ave
Wyckoff, NJ 07481-2133

Phone

(201) 251-2422

Fax

(201) 857-0365

NPI assigned

Feb 15, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1997

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Apex Orthopedic Rehabilitation Inc.

  • Specialist
  • Paramus, NJ
  • NPI 1235332156
  Medicare reassignment NPD Authorized official
• The New Jersey Center of Physical Therapy, PC

  • Physical Therapist
  • Riverdale, NJ
  • NPI 1063508174
  NPD (past)

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1417090697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 CEDAR HILL AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074812133",
            "telephone_number": "201-251-2422",
            "fax_number": "201-857-0365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 CEDAR HILL AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074812133",
            "telephone_number": "201-251-2422",
            "fax_number": "201-857-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLEMANN",
        "first_name": "TOM",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PT,OCS,MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "QA 007709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP ID",
            "identifier": "200847370",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL ID",
            "identifier": "039725",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walter J Kent DDS PA
• Lawrence E. Weiner, D.M.D.
• Mary Catherine Weiss
• Jill Faber Werner, OTR/L
• Judy White
• Tiffani Michelle Winfrey
• Wyckoff Dental Associates, LLC
• Wyckoff Dental Spa LLC
• Wyckoff Family YMCA
• Wyckoff Ophthalmology, LLC

• Specialist in Wyckoff, NJ
• Providers in Wyckoff, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; 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.