Individual provider Active NPI

Justin B Gornell, DPT, OCS

  • Physical Therapist
  • New York, NY
National Provider Identifier
1770550915
Registry record updated Sep 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
NY024310 Issued in NY
Practice address
19 E 80TH St Apt 1E
New York, NY 10075-0170
Phone
(201) 780-9691
Fax
(646) 863-2650
NPI assigned
Mar 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2026

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 NY024310 NY Primary

Addresses

Primary practice location

19 E 80TH St Apt 1E
New York, NY 10075-0170

Mailing address

11 Edgewood Dr
Ho Ho Kus, NJ 07423-1527
Phone (201) 780-9691

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060316000079 NY Practitioner - Physical Therapist in Private Practice 5597772574 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1556 3Rd Ave
Suite 211
New York, NY 10128-3100
Phone (201) 780-9691

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
NY024310NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Paradigm Physical Therapy, P.C. CurrentSince Feb 22, 2010 Accepting new patients

Locations

1556 3rd Ave
Ste 211
New York, NY 10128
Phone (201) 780-9691

Organizations & group practices 1

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": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1770550915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 EDGEWOOD DR",
            "city": "HO HO KUS",
            "state": "NJ",
            "postal_code": "074231527",
            "telephone_number": "201-780-9691",
            "fax_number": "646-863-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 E 80TH ST APT 1E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100750170",
            "telephone_number": "201-780-9691",
            "fax_number": "646-863-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORNELL",
        "first_name": "JUSTIN",
        "middle_name": "B",
        "credential": "DPT, OCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-07",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "NY024310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; 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.