Nathanael Park, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

40QB00353800 Issued in NJ

Practice address

749 Marin Ave Unit 1
Lyndhurst, NJ 07071-2521

Phone

(201) 916-1681

NPI assigned

Feb 16, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Theraflex Physical Therapy LLC

  • Physical Therapist
  • Lyndhurst, NJ
  • NPI 1851196208

  Physical Therapy Assistant

  NPD Authorized official

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

{
    "created_epoch": "1708041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1427813617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "749 MARIN AVE UNIT 1",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070712521",
            "telephone_number": "201-916-1681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "749 MARIN AVE UNIT 1",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070712521",
            "telephone_number": "201-916-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "NATHANAEL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-16",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NJ",
            "license": "40QB00353800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reggie Palatty, PHARMD
• Park Avenue Dental of NJ
• Park Avenue Medical Associates, P.a.
• Brian Park, PHARMD
• Byong K. Park, M.D.
• Parkway Ambulatory Surgery Center LLC
• Shiela Villanueva Pascual, OT
• Passaic River Rowing Association
• Kajal Patel
• Kumar Patel, M.D.

• Physical Therapy Assistant in Lyndhurst, NJ
• Providers in Lyndhurst, NJ by specialty
• Physical Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.