Edward Evanchick, P.T.
Individual provider Active NPI Physical Therapist · Haskell, NJ
NPI 1457474256 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1457474256
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- Practice address
- 25 5TH Ave
Haskell, NJ 07420-1075 - Phone
- (973) 839-6000
- NPI assigned
- Apr 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lotus98 LLC
Practice addresses (Care Compare)
1141 Greenwood Lake Tpke
Ringwood, NJ 07456-1402
Phone (973) 330-8355
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140603002175 | NJ | Practitioner - Physical Therapist in Private Practice | 0840428074 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QAO1070200 | NJ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lotus98 LLC | Physical Therapist | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | NJ | Yes |
Addresses
Primary practice location
25 5TH Ave
Haskell, NJ 07420-1075
Mailing address
22 Pine LN
West Milford, NJ 07480-2351
Phone (973) 728-9539
Other providers in Haskell, NJ
- Marcelino Anthony Dizon
- DO Well Be Well of Haskell
- Melinda Donohue
- Kelly Maria Doyle
- Eon Therapy Services LLC
- Danielle Nicoletta Falciglia
- Vanessa Fernandez
- Shannon Finn
- Jennan Gallanthen
- Jennifer Marie Georgiadis
All providers in Haskell, NJ · Physical Therapist in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.