NPIMap

Organization Active NPI

Spine & Sports Medicine of Lincroft, LLC

  • Physical Medicine & Rehabilitation Physician
  • Lincroft, NJ
National Provider Identifier
1649832197
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
SPINE & SPORTS MEDICINE OF LINCROFT, LLC
Practice address
5 Swimming River Rd
Lincroft, NJ 07738-1725
Phone
(324) 514-5787
Fax
(732) 530-3561
NPI assigned
Jul 5, 2019
Last updated
May 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicole Fullaway, PT, DPTNPI 1235442690
Title
Director
Phone
(732) 714-0070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU
Acupuncturist 171100000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

5 Swimming River Rd
Lincroft, NJ 07738-1725

Mailing address

3 Swimming River Rd
Lincroft, NJ 07738-1725
Phone (732) 653-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200313000364 NJ Part B Supplier - Clinic/Group Practice 4688002264 Receives reassigned benefits from 18 practitioners
Practice locations: Lincroft, NJ
O20200904001226 NJ DME Supplier - Independently-Practicing Physical Therapist 4688002264 Practice locations: Lincroft, NJ

National Provider Directory

National Provider Directory

Locations

3 Swimming River Rd
Lincroft, NJ 07738

5 Swimming River Rd
Lincroft, NJ 07738
Phone (732) 451-4578

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1562284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1649832197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 SWIMMING RIVER RD",
            "city": "LINCROFT",
            "state": "NJ",
            "postal_code": "077381725",
            "telephone_number": "732-653-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 SWIMMING RIVER RD",
            "city": "LINCROFT",
            "state": "NJ",
            "postal_code": "077381725",
            "telephone_number": "324-514-5787",
            "fax_number": "732-530-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE & SPORTS MEDICINE OF LINCROFT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-05",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "FULLAWAY",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "732-714-0070",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincroft, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.