Active NPI
Rey Moises Fajardo Vitug, PTA
- Physical Therapy Assistant
- Orange, NJ
National Provider Identifier
1538331442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 40QB00194900
- Practice address
- 560 Berkeley Ave
Orange, NJ 07050-2109 - Phone
- (973) 672-6500
- NPI assigned
- Mar 31, 2008
- Last updated
- Sep 20, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 40QB00194900 | NJ | Primary |
Addresses
Primary practice location
560 Berkeley Ave
Orange, NJ 07050-2109
Mailing address
9 Towers St
Jersey City, NJ 07305-1004
Phone (201) 333-8987
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QB00194900 | NJ | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316476800000",
"number": "1538331442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 TOWERS ST",
"city": "JERSEY CITY",
"state": "NJ",
"postal_code": "073051004",
"telephone_number": "201-333-8987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "560 BERKELEY AVE",
"city": "ORANGE",
"state": "NJ",
"postal_code": "070502109",
"telephone_number": "973-672-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VITUG",
"first_name": "REY MOISES",
"middle_name": "FAJARDO",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-31",
"last_updated": "2011-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NJ",
"license": "40QB00194900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.