NPIMap

Individual provider Active NPI

Matthew Mandel

  • Physical Therapist
  • Boonton, NJ
National Provider Identifier
1689763203
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA00763200 Issued in NJ
Practice address
304 Wootton St
Suite 2B
Boonton, NJ 07005-1951
Phone
(973) 402-4300
Fax
(973) 402-0066
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

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 40QA00763200 NJ Primary

Addresses

Primary practice location

304 Wootton St
Suite 2B
Boonton, NJ 07005-1951

Mailing address

5 Jefferson CT
Montville, NJ 07045-9155

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040827000911 NJ Practitioner - Physical Therapist in Private Practice 9638144280 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA00763200NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Physical Therapy LLC Physical Therapist CurrentSince Apr 15, 2025 Accepting new patients
Trinity Rehab Somerset PA CurrentSince Aug 4, 2020 Accepting new patients
Denville Medical Health Center & Sports Rehab P.C. CurrentSince Aug 21, 2018 Accepting new patients
Trinity Rehab Somerset PA Physical Therapist CurrentSince Aug 4, 2020 Accepting new patients
Ignite Rehab Corp Physical Therapist CurrentSince Jul 1, 2023 Accepting new patients
Trinity Rehab Somerset PA Physical Therapist Current Accepting new patients
Sportscare Institute, Inc. Physical Therapist Past Accepting new patients
Center for Advanced Sports Medicine, Knee and Shoulder, LLC Past Accepting new patients
Sportscare of America, PC Physical Therapist PastSince Jan 10, 2007 Accepting new patients

Locations

1003 Main Ave
Clifton, NJ 07011
Phone (201) 344-2499

161 E Main St
Ste 200
Denville, NJ 07834
Phone (973) 627-7888

328 Newman Springs Rd
Ste 10
Red Bank, NJ 07701

175 Route 37 W
#R
Toms River, NJ 08755

800 E Gate Blvd
Garden City, NY 11530

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14248/brand/1/csg/1/fhir/r4

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295913600000",
    "number": "1689763203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 JEFFERSON CT",
            "city": "MONTVILLE",
            "state": "NJ",
            "postal_code": "070459155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 WOOTTON ST",
            "address_2": "SUITE 2B",
            "city": "BOONTON",
            "state": "NJ",
            "postal_code": "070051951",
            "telephone_number": "973-402-4300",
            "fax_number": "973-402-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDEL",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2011-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00763200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boonton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; 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.