Individual provider Active NPI

Anthony T Walsh

  • Physical Therapist
  • Ridgewood, NJ
National Provider Identifier
1417565987
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01925400 Issued in NJ
Practice address
85 S Maple Ave Ste 1
Ridgewood, NJ 07450-4500
Phone
(201) 857-5396
Fax
(201) 857-5398
NPI assigned
Jul 21, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 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 40QA01925400 NJ Primary

Addresses

Primary practice location

85 S Maple Ave Ste 1
Ridgewood, NJ 07450-4500

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200724000325 NJ Practitioner - Physical Therapist in Private Practice 7618391574 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Occupational and Physical Therapy, PLLCGroup PAC ID 3779873401, 497 clinicians

Practice addresses (Care Compare)

776 N Rte
Suite 17
Paramus, NJ 07652-3117
Phone (201) 225-9222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01925400NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rothman Institute of New Jersey, P.a. CurrentSince Nov 1, 2020 Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Jul 27, 2020 Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist Current Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Jul 27, 2020 Accepting new patients
Rothman Orthopaedics of New Jersey, LLC CurrentSince Nov 1, 2020 Accepting new patients

Locations

999 Route 73 N
Ste 401
Marlton, NJ 08053

187 Millburn Ave
Ste 110
Millburn, NJ 07041
Phone (973) 467-7976

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

776 N Route 17
Paramus, NJ 07652
Phone (201) 225-9222

85 S Maple Ave
Ste 1
Ridgewood, NJ 07450
Phone (201) 857-5396

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

576 Broadhollow Rd
Melville, NY 11747

Organizations & group practices 5

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": "1595289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595289600000",
    "number": "1417565987",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 S MAPLE AVE STE 1",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074504500",
            "telephone_number": "201-857-5396",
            "fax_number": "201-857-5398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "ANTHONY",
        "middle_name": "T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-21",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01925400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; 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.