Individual provider Active NPI

Tyler P Sansone, PA-C

  • Physician Assistant
  • Hackensack, NJ
National Provider Identifier
1689569683
Registry record updated Aug 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
20 Prospect Ave Ste 907
Hackensack, NJ 07601-1989
Phone
(201) 342-2550
NPI assigned
Jun 10, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NJ Primary

Addresses

Primary practice location

20 Prospect Ave Ste 907
Hackensack, NJ 07601-1989

Mailing address

112 Hoover Ave Apt 4
Edison, NJ 08837-2684
Phone (908) 783-9130

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251027004619 NJ Practitioner - Physician Assistant 9537658984 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Jersey Brain and Spine PCGroup PAC ID 8123013802, 41 clinicians

Practice addresses (Care Compare)

32 Philips Pkwy
Montvale, NJ 07645-1811
Phone (201) 342-2550

Hospital & facility affiliations

  • Hackensack University Medical Center Hospital, Hackensack, NJ, CCN 310001
  • Hackensack Meridian Health Pascack Valley Medical Hospital, Westwood, NJ, CCN 310130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New Jersey Brain & Spine PC CurrentSince Sep 1, 2025 Accepting new patients

Locations

20 Prospect Ave
Ste 907
Hackensack, NJ 07601
Phone (201) 996-2750

32 Philips Pkwy
Montvale, NJ 07645
Phone (201) 494-4479

680 Kinderkamack Rd
Ste 300
Oradell, NJ 07649
Phone (201) 881-7869

650 From Rd
Ste 220
Paramus, NJ 07652

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 and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1749513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754697600000",
    "number": "1689569683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 HOOVER AVE APT 4",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088372684",
            "telephone_number": "908-783-9130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 PROSPECT AVE STE 907",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011989",
            "telephone_number": "201-342-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANSONE",
        "first_name": "TYLER",
        "middle_name": "P",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-10",
        "last_updated": "2025-08-09",
        "certification_date": "2025-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.