NPIMap

Organization Active NPI

Innovative Physical Therapy and Fitness Center Inc

  • Physical Therapy Clinic/Center
  • Kendall Park, NJ
National Provider Identifier
1740548742
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
40QA01115800 Issued in NJ
Legal business name
INNOVATIVE PHYSICAL THERAPY AND FITNESS CENTER INC
Practice address
3562 Route 27
Suite 124
Kendall Park, NJ 08824
Phone
(732) 853-8177
NPI assigned
Apr 26, 2012
Last updated
May 12, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Authorized official

Name
Suresh Babu, PT,DPT,MSNPI 1659434538
Title
President
Phone
(732) 853-8177

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 40QA01115800 NJ Primary

Addresses

Primary practice location

3562 Route 27
Suite 124
Kendall Park, NJ 08824

Mailing address

3562 Route 27
Suite 124
Kendall Park, NJ 08824
Phone (732) 853-8177

Other identifiers 1

IdentifierTypeStateIssuer
180947DBDOtherMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121228000153 NJ Part B Supplier - Clinic/Group Practice 1456504331 Receives reassigned benefits from 25 practitioners
Practice locations: Edison, NJ; Kendall Park, NJ; Princeton, NJ
O20220128001374 NJ DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 1456504331 Practice locations: Kendall Park, NJ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Innovative Phyl Thpy5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3562 State Route 27
Ste 124
Kendall Park, NJ 08824
Phone (732) 317-4105

10 Jefferson Plz
Ste 100B
Princeton, NJ 08540
Phone (908) 721-1906

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1335398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1740548742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3562 ROUTE 27",
            "address_2": "SUITE 124",
            "city": "KENDALL PARK",
            "state": "NJ",
            "postal_code": "08824",
            "telephone_number": "732-853-8177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3562 ROUTE 27",
            "address_2": "SUITE 124",
            "city": "KENDALL PARK",
            "state": "NJ",
            "postal_code": "08824",
            "telephone_number": "732-853-8177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PHYSICAL THERAPY AND FITNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-26",
        "last_updated": "2021-05-12",
        "certification_date": "2021-04-19",
        "status": "A",
        "authorized_official_last_name": "BABU",
        "authorized_official_first_name": "SURESH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-853-8177",
        "authorized_official_credential": "PT,DPT,MS"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NJ",
            "license": "40QA01115800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "180947DBD",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kendall Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.