Port Imperial Therapy Group LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PORT IMPERIAL THERAPY GROUP LLC

Practice address

500 Ave at Port Imperial Blvd Ste 110
Weehawken, NJ 07086-7542

Phone

(201) 272-9400

NPI assigned

Jan 10, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Jaclyn Fulop

Title

Clinic Director

Phone

(201) 272-9400

Specialties & licenses 1

Addresses

Other names 1

• Port Imperial Therapy Group Former legal business name

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elizabeth Kwon, DPT

  • Physical Therapist
  • Weehawken, NJ
  • NPI 1235864257
  Medicare reassignment Care Compare group NPD
• Moura Ibrahim, DPT

  • Physical Therapist
  • Weehawken, NJ
  • NPI 1497438287
  Medicare reassignment Care Compare group
• Kristina Mueller

  • Physical Therapist
  • Weehawken, NJ
  • NPI 1346928967
  Medicare reassignment Care Compare group
• Paige Smith

  • Physical Therapist
  • Weehawken, NJ
  • NPI 1598372955
  Medicare reassignment Care Compare group
• Erin Granahan

  • Physical Therapy Assistant
  • Weehawken, NJ
  • NPI 1477070563
  NPD
• Elizabeth Mancini, DPT

  • Physical Therapist
  • Weehawken, NJ
  • NPI 1023660537
  NPD
• Adrian Inhulsen, PTA

  • Physical Therapy Assistant
  • Weehawken, NJ
  • NPI 1659858363
  NPD (past)
• Zachary Mease, DPT

  • Physical Therapist
  • Wilmington, DE
  • NPI 1720507015
  NPD (past)

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

{
    "created_epoch": "1484006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755129600000",
    "number": "1679019996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 AVE AT PORT IMPERIAL BLVD STE 110",
            "city": "WEEHAWKEN",
            "state": "NJ",
            "postal_code": "070867542",
            "telephone_number": "201-272-9400",
            "fax_number": "201-272-9402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 AVE AT PORT IMPERIAL BLVD STE 110",
            "city": "WEEHAWKEN",
            "state": "NJ",
            "postal_code": "070867542",
            "telephone_number": "201-272-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT IMPERIAL THERAPY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-10",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A",
        "authorized_official_last_name": "FULOP",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "201-272-9400",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port Imperial Therapy Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Physical Therapist in Weehawken, NJ
• Providers in Weehawken, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2025; 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.