Individual provider Active NPI

Nicole A Vasiliu, DPT

  • Physical Therapist
  • Manchester, NJ
National Provider Identifier
1679098677
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01934400 Issued in NJ
Practice address
2915 Ridgeway Rd
Manchester, NJ 08759-4755
Phone
(732) 657-7900
NPI assigned
Aug 10, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT026308 PA
Physical Therapist 225100000X 40QA01934400 NJ Primary

Addresses

Primary practice location

2915 Ridgeway Rd
Manchester, NJ 08759-4755

Mailing address

1377 Motor Pkwy Ste 307
Islandia, NY 11749-5258
Phone (914) 294-4050

Other practice location 1

5425 Jonestown Rd Ste 100
Harrisburg, PA 17112-4086
Phone (717) 901-6245

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201207000105 NJ Practitioner - Physical Therapist in Private Practice 5991070252 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
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)

2915 Ridgeway Rd
Manchester, NJ 08759-4755
Phone (732) 657-7900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT026308PAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Network Inc. Physical Therapist Current Accepting new patients
Advanced Wellness Physical Therapist CurrentSince Dec 22, 2020 Accepting new patients
Atlantic Physical Therapy Center CurrentSince Nov 3, 2020 Accepting new patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Mar 25, 2021 Accepting new patients
Atlantic Physical Therapy Center Physical Therapist CurrentSince Nov 3, 2020 Accepting new patients
Ivyrehab Network Inc Physical Therapist CurrentSince Mar 25, 2021 Accepting new patients

Locations

74 Brick Blvd
Ste 116
Brick, NJ 08723
Phone (732) 451-0010

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

718B Buckingham Dr
Lakewood, NJ 08701
Phone (732) 456-8310

1037 Route 70
Manchester, NJ 08759
Phone (732) 408-1800

2915 Ridgeway Rd
Manchester, NJ 08759
Phone (732) 657-7900

17 N Main St
Marlboro, NJ 07746
Phone (732) 431-2155

1500 Meeting House Rd
Sea Girt, NJ 08750
Phone (732) 722-8787

1377 Motor Pkwy
Ste 307
Ronkonkoma, NY 11749

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, 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": "1502323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1679098677",
    "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": "914-294-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 RIDGEWAY RD",
            "city": "MANCHESTER",
            "state": "NJ",
            "postal_code": "087594755",
            "telephone_number": "732-657-7900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5425 Jonestown Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "PA",
            "postal_code": "171124086",
            "country_code": "US",
            "telephone_number": "717-901-6245",
            "fax_number": "717-901-9488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VASILIU",
        "first_name": "NICOLE",
        "middle_name": "A",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-10",
        "last_updated": "2022-07-21",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT026308",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01934400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.