Michael James Wylykanowitz Jr., DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01398100 Issued in NJ

Practice address

34 Mountain Blvd
Building C
Warren, NJ 07059-2640

Phone

(908) 222-0515

Fax

(908) 222-0516

NPI assigned

Jun 20, 2011

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

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jag-One Physical Therapy LLCGroup PAC ID 2769584325, 334 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Jag-One Physical Therapy, LLC

  • Physical Therapist
  • West Orange, NJ
  • NPI 1518017144
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453766400000",
    "number": "1457647307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 EAGLE ROCK AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522994",
            "telephone_number": "973-669-0078",
            "fax_number": "973-669-1113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 MOUNTAIN BLVD",
            "address_2": "BUILDING C",
            "city": "WARREN",
            "state": "NJ",
            "postal_code": "070592640",
            "telephone_number": "908-222-0515",
            "fax_number": "908-222-0516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYLYKANOWITZ",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_suffix": "Jr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-20",
        "last_updated": "2016-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01398100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynda Witcoski, NP
• Alan Harley Wolff, M.D.
• Women'S Health Care of Warren, PA
• Delores Wong, RPH, PHARMD
• Christie Wukovits, DPT
• Grethe Yackanin, MA, BCBA
• Yanaphleb
• Roger S Yang, MD
• Warren J Yang, PT, DPT
• Lindsey Yasyukevich, MD

• Physical Therapist in Warren, NJ
• Providers in Warren, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; 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.