Individual provider Active NPI

Jason De la Bruyere, DPT

  • Physical Therapist
  • Paramus, NJ
National Provider Identifier
1598090169
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01325400 Issued in NJ
Practice address
28 Farview Ter
Paramus, NJ 07652-2740
Phone
(201) 880-9810
NPI assigned
Oct 14, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

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 40QA01325400 NJ Primary

Addresses

Primary practice location

28 Farview Ter
Paramus, NJ 07652-2740

Mailing address

28 Farview Ter
Paramus, NJ 07652-2740
Phone (201) 880-9810

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100304000952 NJ Practitioner - Physical Therapist in Private Practice 2961547609 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Paramus Orthopedic Physical Therapy,PCGroup PAC ID 2062642937, 11 clinicians

Practice addresses (Care Compare)

28 Farview Ter
Paramus, NJ 07652-2740
Phone (201) 880-9810

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01325400NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Paramus Orthopedic Physical Therapy, PC Physical Therapist CurrentSince Jun 27, 2014 Accepting new patients
Wayne Orthopedic Physical Therapy, PC Physical Therapist CurrentSince Aug 23, 2010 Accepting new patients
Montville Physical Therapy, PC CurrentSince Oct 1, 2021 Accepting new patients
The New Jersey Center of Physical Therapy, PC Physical Therapist CurrentSince Aug 14, 2009 Accepting new patients
Paramus Orthopedic Physical Therapy PastSince Jun 27, 2014 Accepting new patients
Wayne Foot and Ankle Center,PA PastSince Aug 23, 2010 Accepting new patients

Locations

2 Changebridge Rd
Ste F
Montville, NJ 07045
Phone (973) 917-3134

2 Changebridge Rd
#F
Montville, NJ 07045
Phone (973) 917-3134

28 Farview Ter
Paramus, NJ 07652
Phone (201) 880-9810

49 Hamburg Tpke
Riverdale, NJ 07457
Phone (973) 248-8111

69 Newark Pompton Tpke
Riverdale, NJ 07457
Phone (973) 248-8111

450 Hamburg Tpke
Wayne, NJ 07470
Phone (973) 706-7620

Organizations & group practices 6

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": "1255478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1598090169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 FARVIEW TER",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076522740",
            "telephone_number": "201-880-9810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 FARVIEW TER",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076522740",
            "telephone_number": "201-880-9810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA BRUYERE",
        "first_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-14",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01325400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paramus, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; 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.