Organization Active NPI

Equilibrium, LLC

  • Physical Therapist
  • Fort Lee, NJ
National Provider Identifier
1710383419
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
EQUILIBRIUM, LLC
Practice address
158 Linwood PLZ Ste 308
Fort Lee, NJ 07024-3704
Phone
(201) 461-9333
Fax
(201) 461-0851
NPI assigned
Nov 7, 2014
Last updated
Oct 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Authorized official

Name
Dr. David ParkNPI 1689041659
Title
President
Phone
(201) 233-0223

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

158 Linwood PLZ Ste 308
Fort Lee, NJ 07024-3704

Mailing address

158 Linwood PLZ Ste 308
Fort Lee, NJ 07024-3704
Phone (201) 461-9333

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151022000114 NJ Part B Supplier - Clinic/Group Practice 7315256906 Receives reassigned benefits from 5 practitioners
Practice locations: Fort Lee, NJ

National Provider Directory

National Provider Directory

Locations

158 Linwood Plz
Ste 219
Fort Lee, NJ 07024
Phone (201) 233-0223

158 Linwood Plz
Ste 308
Fort Lee, NJ 07024
Phone (201) 461-9333

158 Linwood Plz
Ste 308310
Fort Lee, NJ 07024
Phone (201) 461-9333

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1415318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1710383419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 LINWOOD PLZ STE 308",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070243704",
            "telephone_number": "201-461-9333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 LINWOOD PLZ STE 308",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070243704",
            "telephone_number": "201-461-9333",
            "fax_number": "201-461-0851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EQUILIBRIUM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-07",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-233-0223",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "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 Oct 30, 2023; 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.