Amy Q Banaga, PT

Key facts

NPI

1780889170

Entity type

Individual (NPI type 1)

Primary specialty

Specialist 174400000X

License

40QA01173600 (NJ)

Practice address

26 Haliday St
Clark, NJ 07066-1833

Phone

(201) 486-5795

NPI assigned

Jun 18, 2007

Sex

Female

Sole proprietor

Yes

Organizations & group practices 4

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.

• East Coast Rehabilitation Services LLC Physical Therapy Clinic/Center · Kenilworth, NJ · NPI 1417228917
  Medicare reassignment Care Compare group NPD NJ
• Comfort Nest Homes Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Clark, NJ · NPI 1457234353
  NPD (past) Authorized official
• Comfort Nest Homes Intellectual and/or Developmental Disabilities Residential Treatment Facility · Clark, NJ · NPI 1891625224
  NPD (past) Authorized official
• Ascend Psychiatry, PC Psychiatry Physician · Union, NJ · NPI 1457215469
  NPD (past)

Medicare Care Compare profile

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

East Coast Rehabilitation Services LLC (5 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in NJ

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 5, 2009.

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254700800000",
    "number": "1780889170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 HALIDAY ST",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661833",
            "telephone_number": "201-486-5795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 HALIDAY ST",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661833",
            "telephone_number": "201-486-5795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANAGA",
        "first_name": "AMY",
        "middle_name": "Q",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-18",
        "last_updated": "2009-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "40QA01173600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Clark, NJ · Specialist in New Jersey