Individual provider Active NPI

Diana Mikula, PT DPT

  • Physical Therapist
  • Denville, NJ
National Provider Identifier
1629682877
Registry record updated Sep 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01956300 Issued in NJ
Practice address
109 Route 46
Denville, NJ 07834-2776
Phone
(973) 625-0744
Fax
(973) 625-0741
NPI assigned
Sep 4, 2020
Last updated
Sep 4, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2020

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 40QA01956300 NJ Primary

Addresses

Primary practice location

109 Route 46
Denville, NJ 07834-2776

Mailing address

1377 Motor Pkwy Ste 307
Islandia, NY 11749-5258
Phone (631) 580-5200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201006000307 NJ Practitioner - Physical Therapist in Private Practice 6305265620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Network IncGroup PAC ID 3476539776, 658 clinicians

Practice addresses (Care Compare)

109 Route 46
Denville, NJ 07834-2776
Phone (973) 625-0744

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01956300NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Network Inc. Physical Therapist CurrentSince Sep 8, 2020 Accepting new patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Sep 8, 2020 Accepting new patients

Locations

925 Clifton Ave
Ste 102
Clifton, NJ 07013
Phone (973) 330-0705

731 Lacey Rd
Ste 3
Forked River, NJ 08731
Phone (609) 242-6780

454 Passaic St
Hackensack, NJ 07601
Phone (201) 488-7905

437 Route 46
Rockaway, NJ 07866
Phone (973) 366-0402

1377 Motor Pkwy
Ste 307
Ronkonkoma, NY 11749

Organizations & group practices 2

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": "1599177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599177600000",
    "number": "1629682877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "631-580-5200",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 ROUTE 46",
            "city": "DENVILLE",
            "state": "NJ",
            "postal_code": "078342776",
            "telephone_number": "973-625-0744",
            "fax_number": "973-625-0741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKULA",
        "first_name": "DIANA",
        "credential": "PT  DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-04",
        "last_updated": "2020-09-04",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01956300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denville, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2020; 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.