Individual provider Active NPI

Elise Burnett, PT

  • Physical Therapist
  • Glen Rock, NJ
National Provider Identifier
1780052076
Registry record updated Sep 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01616000 Issued in NJ
Practice address
786 S Maple Ave
Glen Rock, NJ 07452-2817
Phone
(973) 508-9034
NPI assigned
Sep 3, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 3, 2015

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 40QA01616000 NJ Primary

Addresses

Primary practice location

786 S Maple Ave
Glen Rock, NJ 07452-2817

Mailing address

786 S Maple Ave
Glen Rock, NJ 07452-2817
Phone (973) 508-9034

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150929001225 NJ Practitioner - Physical Therapist in Private Practice 5395053144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Network IncGroup PAC ID 3476539776, 658 clinicians

Practice addresses (Care Compare)

1230 A Morris Ave
Union, NJ 07083-3308
Phone (908) 315-0189

454 Passaic St
Hackensack, NJ 07601-1519
Phone (201) 488-7905

456 Prospect Ave
Suite C
West Orange, NJ 07052-4112
Phone (973) 651-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01616000NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Network Inc. Physical Therapist CurrentSince Sep 1, 2015 Accepting new patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Sep 1, 2015 Accepting new patients

Locations

454 Passaic St
Hackensack, NJ 07601
Phone (201) 488-7905

1230 Morris Ave
#A
Union, NJ 07083
Phone (908) 315-0189

4175 Veterans Memorial Hwy
Ste 202
Ronkonkoma, NY 11779

Organizations & group practices 2

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": "1441238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441238400000",
    "number": "1780052076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "786 S MAPLE AVE",
            "city": "GLEN ROCK",
            "state": "NJ",
            "postal_code": "074522817",
            "telephone_number": "973-508-9034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "786 S MAPLE AVE",
            "city": "GLEN ROCK",
            "state": "NJ",
            "postal_code": "074522817",
            "telephone_number": "973-508-9034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNETT",
        "first_name": "ELISE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-03",
        "last_updated": "2015-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01616000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Rock, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; 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.