Individual provider Active NPI

Kevin Corso, PT

  • Physical Therapist
  • Fort Lee, NJ
National Provider Identifier
1699008094
Registry record updated Sep 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01329700 Issued in NJ
Practice address
1355 15TH St
Fort Lee, NJ 07024-2039
Phone
(201) 224-8717
Fax
(201) 224-6381
NPI assigned
Sep 16, 2009
Last updated
Sep 16, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2009

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 40QA01329700 NJ Primary

Addresses

Primary practice location

1355 15TH St
Fort Lee, NJ 07024-2039

Mailing address

605 Main St
Hackensack, NJ 07601-5914
Phone (201) 488-0488

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091019000237 NJ Practitioner - Physical Therapist in Private Practice 6608913983 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1055 Hamburg Tpke
Wayne, NJ 07470-3235
Phone (973) 305-0064

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01329700NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Dec 1, 2017 Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist Current Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Dec 1, 2017 Accepting new patients

Locations

226 Middle Rd
Hazlet, NJ 07730
Phone (732) 264-7615

1 Greenwood Ave
Montclair, NJ 07042
Phone (973) 746-2424

524 Williamstown Rd
Ste B1
Sicklerville, NJ 08081
Phone (856) 516-0591

68 River Rd
Summit, NJ 07901
Phone (908) 277-0800

1055 Hamburg Tpke
Wayne, NJ 07470
Phone (973) 305-0064

576 Broadhollow Rd
Melville, NY 11747

Organizations & group practices 3

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": "1253059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253059200000",
    "number": "1699008094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076015914",
            "telephone_number": "201-488-0488",
            "fax_number": "201-224-6381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 15TH ST",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070242039",
            "telephone_number": "201-224-8717",
            "fax_number": "201-224-6381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORSO",
        "first_name": "KEVIN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-16",
        "last_updated": "2009-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01329700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lee, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2009; 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.