Individual provider Active NPI

Isaac Garrett Kebabjian, DC

  • Chiropractor
  • Clifton, NJ
National Provider Identifier
1699288696
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
38MC00749200 Issued in NJ
Practice address
62 Strangeway Ter
Clifton, NJ 07011-3844
Phone
(862) 256-0353
NPI assigned
Nov 13, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 38MC00749200 NJ Primary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 08003109A IN

Addresses

Primary practice location

62 Strangeway Ter
Clifton, NJ 07011-3844

Mailing address

62 Strangeway Ter
Clifton, NJ 07011-3844
Phone (862) 256-0353

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171211000199 NJ Practitioner - Chiropractic 6406114909 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
08003109AINMDChiropractor
38MC00749200NJMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Chiropractic Works, LLC Chiropractor CurrentSince Nov 14, 2017 Accepting new patients
KB Restorative Wellness Chiropractor CurrentSince May 29, 2022 Accepting new patients
Colonia Spine & Wellness Center PA Chiropractor CurrentSince Apr 1, 2022 Accepting new patients

Locations

15 Prospect Ln
Ste 1D
Colonia, NJ 07067
Phone (732) 661-1121

340 Ramapo Valley Rd
Oakland, NJ 07436
Phone (201) 644-0860

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1699288696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 STRANGEWAY TER",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070113844",
            "telephone_number": "862-256-0353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 STRANGEWAY TER",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070113844",
            "telephone_number": "862-256-0353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEBABJIAN",
        "first_name": "ISAAC",
        "middle_name": "GARRETT",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-11-13",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00749200",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08003109A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clifton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; 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.