Active NPI
Nelson Avbadevboro
- Physical Therapy Assistant
- Belleville, NJ
National Provider Identifier
1427454966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 40QB00292100
- Practice address
- 710 Mill St
Unit H3
Belleville, NJ 07109-5318 - Phone
- (973) 759-1494
- Fax
- (973) 759-0557
- NPI assigned
- Nov 11, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 40QB00292100 | NJ | Primary |
Addresses
Primary practice location
710 Mill St
Unit H3
Belleville, NJ 07109-5318
Mailing address
543 Forest Ave
Lyndhurst, NJ 07071-2437
Phone (347) 665-5629
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QB00292100 | NJ | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415664000000",
"number": "1427454966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "543 FOREST AVE",
"city": "LYNDHURST",
"state": "NJ",
"postal_code": "070712437",
"telephone_number": "347-665-5629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 MILL ST",
"address_2": "UNIT H3",
"city": "BELLEVILLE",
"state": "NJ",
"postal_code": "071095318",
"telephone_number": "973-759-1494",
"fax_number": "973-759-0557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVBADEVBORO",
"first_name": "NELSON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-11-11",
"last_updated": "2014-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NJ",
"license": "40QB00292100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belleville, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.