NPIMap

Organization Active NPI

Ivyrehab Network Inc

  • Physical Therapist
  • Raritan, NJ
National Provider Identifier
1497352041
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
IVYREHAB NETWORK INC
Practice address
503 Route 202 Unit C
Raritan, NJ 08869-1535
Phone
(908) 800-7870
Fax
(908) 800-7871
NPI assigned
Oct 7, 2020
Last updated
Aug 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Authorized official

Name
Michael Rucker
Title
Ceo
Phone
(914) 777-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

503 Route 202 Unit C
Raritan, NJ 08869-1535

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224
Phone (914) 294-4050

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211008001362 NJ DME Supplier - Independently-Practicing Occupational TherapistDME Supplier - Independently-Practicing Physical Therapist 3476539776 Practice locations: Raritan, NJ

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Ivyrehab Network Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

503 Route 202
Unit C
Raritan, NJ 08869
Phone (908) 800-7870

NPI Registry JSON

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

{
    "created_epoch": "1602028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1497352041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 ROUTE 202 UNIT C",
            "city": "RARITAN",
            "state": "NJ",
            "postal_code": "088691535",
            "telephone_number": "908-800-7870",
            "fax_number": "908-800-7871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVYREHAB NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-07",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "RUCKER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "914-777-8700"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raritan, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.