Jack Brett Passarella, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

18KT00278700 Issued in NJ

Practice address

12 W Taunton Ave
Berlin, NJ 08009-1442

Phone

(856) 768-6444

Fax

(856) 768-6412

NPI assigned

Aug 1, 2017

Last updated

Mar 17, 2018By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1497279376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 CHESTNUT ST",
            "city": "ATCO",
            "state": "NJ",
            "postal_code": "080042127",
            "telephone_number": "856-767-9109",
            "fax_number": "856-767-9109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 W TAUNTON AVE",
            "city": "BERLIN",
            "state": "NJ",
            "postal_code": "080091442",
            "telephone_number": "856-768-6444",
            "fax_number": "856-768-6412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "332 Haddon Ave",
            "address_purpose": "LOCATION",
            "city": "Haddon Township",
            "state": "NJ",
            "postal_code": "081082833",
            "country_code": "US",
            "telephone_number": "609-707-1096",
            "fax_number": "856-768-6412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PASSARELLA",
        "first_name": "JACK",
        "middle_name": "BRETT",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-01",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NJ",
            "license": "18KT00278700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.