Individual provider Active NPI

Maxine Brandeal

  • Physical Therapist
  • Belmar, NJ
National Provider Identifier
1629511423
Registry record updated Nov 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01671900 Issued in NJ
Practice address
508 10TH Ave
Belmar, NJ 07719-2317
Phone
(732) 910-9196
NPI assigned
Nov 28, 2016
Last updated
Nov 28, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2016

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 40QA01671900 NJ Primary

Addresses

Primary practice location

508 10TH Ave
Belmar, NJ 07719-2317

Mailing address

508 10TH Ave
Belmar, NJ 07719-2317

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170111000428 NJ Practitioner - Physical Therapist in Private Practice 0648551341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coastal Home Rehabilitation, LLCGroup PAC ID 0345418646, 50 clinicians

Practice addresses (Care Compare)

508 10TH Ave
Belmar, NJ 07719-2317
Phone (908) 670-6695

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01671900NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Home Rehabilitation, LLC Physical Therapist CurrentSince Dec 7, 2016 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480291200000",
    "number": "1629511423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 10TH AVE",
            "city": "BELMAR",
            "state": "NJ",
            "postal_code": "077192317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 10TH AVE",
            "city": "BELMAR",
            "state": "NJ",
            "postal_code": "077192317",
            "telephone_number": "732-910-9196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDEAL",
        "first_name": "MAXINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-28",
        "last_updated": "2016-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01671900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belmar, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2016; 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.