Kyle Robertson, DC
Individual provider Active NPI Chiropractor · Waldwick, NJ
NPI 1710397229 · NPPES record last updated Aug 31, 2021
Key facts
- NPI
- 1710397229
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 38MC00716200 (NJ)
- Practice address
- 22 Wyckoff Ave Ste 1
Waldwick, NJ 07463-1788 - Phone
- (201) 972-6121
- Fax
- (201) 447-0827
- NPI assigned
- May 6, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2014
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
22 Wyckoff Ave
Suite 1
Waldwick, NJ 07463-1788
Phone (201) 972-6121
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141120001550 | NJ | Practitioner - Chiropractic | 4981826203 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38MC00716200 | NJ | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ferraro Spine & Rehabilitation, PC | Chiropractor | Current |
Accepting new patients |
| Waldwick Family Chiropractic | Chiropractor | Current |
Accepting new patients |
| VG Physical Therapy | Past |
Accepting new patients |
Locations
224 Midland Ave
Saddle Brook, NJ 07663
Phone (973) 478-2122
230 Midland Ave
Saddle Brook, NJ 07663
Phone (973) 478-2122
22 Wyckoff Ave
Ste 1
Waldwick, NJ 07463
Phone (201) 447-0838
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 38MC00716200 | NJ | Yes |
Addresses
Primary practice location
22 Wyckoff Ave Ste 1
Waldwick, NJ 07463-1788
Mailing address
22 Wyckoff Ave Ste 1
Waldwick, NJ 07463-1788
Phone (201) 972-6121
Other practice location 1
224 Midland Ave
Saddle Brook, NJ 07663-6411
Phone (973) 478-2212
Other providers in Waldwick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.