Individual provider Active NPI

Marilu D Coscolluela, PT

  • Physical Therapist
  • West Orange, NJ
National Provider Identifier
1801060579
Registry record updated Apr 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA00647800 Issued in NJ
Practice address
50 Crystal Ave
West Orange, NJ 07052-3546
Phone
(973) 669-8141
Fax
(973) 669-2538
NPI assigned
Apr 14, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 14, 2008

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 40QA00647800 NJ Primary

Addresses

Primary practice location

50 Crystal Ave
West Orange, NJ 07052-3546

Mailing address

50 Crystal Ave
West Orange, NJ 07052-3546
Phone (973) 669-8141

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040921000612 NJ Practitioner - Physical Therapist in Private Practice 4880662519 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology and Rehab PA LLCGroup PAC ID 5193144558, 2 clinicians

Practice addresses (Care Compare)

185 6TH Ave
Suite 1
Paterson, NJ 07524-1247
Phone (201) 655-3207

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology and Rehab PA LLC Physical Therapist CurrentSince Feb 16, 2021 Accepting new patients
Dr Luis F Luna MD LLC CurrentSince Feb 16, 2021 Accepting new patients
Diverse Medical LLC PastSince Aug 19, 2010 Accepting new patients
Premium Medical Care LLC Physical Therapist Past Accepting new patients
Excel Therapeutics, LLC Physical Therapist Past Accepting new patients

Locations

185 6th Ave
Ste 1
Paterson, NJ 07524
Phone (201) 655-3207

32 Hine St
Ste 103
Paterson, NJ 07503
Phone (973) 341-3782

Organizations & group practices 5

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": "1208131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208131200000",
    "number": "1801060579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 CRYSTAL AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070523546",
            "telephone_number": "973-669-8141",
            "fax_number": "973-669-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 CRYSTAL AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070523546",
            "telephone_number": "973-669-8141",
            "fax_number": "973-669-2538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSCOLLUELA",
        "first_name": "MARILU",
        "middle_name": "D",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-14",
        "last_updated": "2008-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00647800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Orange, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; 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.