Individual provider Active NPI

Matthew Lee

  • Physical Therapist
  • Medford, NJ
National Provider Identifier
1477946010
Registry record updated Mar 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01598700 Issued in NJ
Practice address
176 Route 70
Suite 10
Medford, NJ 08055-8704
Phone
(609) 714-7733
Fax
(609) 714-7750
NPI assigned
Mar 6, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2015

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 40QA01598700 NJ Primary

Addresses

Primary practice location

176 Route 70
Suite 10
Medford, NJ 08055-8704

Mailing address

4175 Veterans Memorial Hwy
Ste 202
Ronkonkoma, NY 11779-7639
Phone (631) 580-5200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150401000772 NJ Practitioner - Physical Therapist in Private Practice 5496072472 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Network IncGroup PAC ID 3476539776, 658 clinicians

Practice addresses (Care Compare)

454 Passaic St
Hackensack, NJ 07601-1519
Phone (201) 488-7905

731 Lacey Rd
Suite 3
Forked River, NJ 08731-1364
Phone (609) 242-6780

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Network Inc. Physical Therapist Current Accepting new patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Mar 5, 2015 Accepting new patients
Ivyrehab Network Inc Physical Therapist CurrentSince Mar 5, 2015 Accepting new patients
Star Physical Therapy P.a. Past Accepting new patients

Locations

731 Lacey Rd
Ste 3
Forked River, NJ 08731
Phone (609) 242-6780

454 Passaic St
Hackensack, NJ 07601
Phone (201) 488-7905

176 Route 70
Ste 10
Medford, NJ 08055
Phone (609) 714-7733

1377 Motor Pkwy
Ste 307
Ronkonkoma, NY 11749

4175 Veterans Memorial Hwy
Ste 202
Ronkonkoma, NY 11779

Organizations & group practices 4

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": "1425600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425945600000",
    "number": "1477946010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4175 VETERANS MEMORIAL HWY",
            "address_2": "STE 202",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797639",
            "telephone_number": "631-580-5200",
            "fax_number": "631-580-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 ROUTE 70",
            "address_2": "SUITE 10",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080558704",
            "telephone_number": "609-714-7733",
            "fax_number": "609-714-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-06",
        "last_updated": "2015-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01598700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; 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.