Individual provider Active NPI

Gene Yau, PTA

  • Physical Therapy Assistant
  • Fair Lawn, NJ
National Provider Identifier
1780964502
Registry record updated Mar 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
40QB00279300 Issued in NJ
Practice address
28-12 Broadway
Fair Lawn, NJ 07410-3924
Phone
(201) 475-8482
Fax
(210) 475-8139
NPI assigned
Aug 24, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 40QB00279300 NJ Primary

Addresses

Primary practice location

28-12 Broadway
Fair Lawn, NJ 07410-3924

Mailing address

1377 Motor Pkwy Ste 307
Islandia, NY 11749-5258
Phone (631) 580-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
40QB00279300NJMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1780964502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "631-580-5200",
            "fax_number": "631-580-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28-12 BROADWAY",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103924",
            "telephone_number": "201-475-8482",
            "fax_number": "210-475-8139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAU",
        "first_name": "GENE",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-24",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NJ",
            "license": "40QB00279300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fair Lawn, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.