Shantal Tagalog Tubalado

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

050083 Issued in NY

Practice address

9 Harbor Front CT
Elizabeth, NJ 07206-1951

Phone

(848) 236-6636

NPI assigned

Dec 13, 2023

Last updated

Dec 13, 2023By the provider in NPPES

Sex

Female

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

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1702425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1528836038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 HARBOR FRONT CT",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072061951",
            "telephone_number": "848-236-6636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 HARBOR FRONT CT",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072061951",
            "telephone_number": "848-236-6636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUBALADO",
        "first_name": "SHANTAL",
        "middle_name": "TAGALOG",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-13",
        "last_updated": "2023-12-13",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "050083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Elizabeth, NJ
• Providers in Elizabeth, NJ by specialty
• Physical Therapy Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.