William Domke II

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA02095600 Issued in NJ

Practice address

11 Eagle Rock Ave Ste 103
East Hanover, NJ 07936-3167

Phone

(973) 887-9000

Fax

(973) 887-3816

NPI assigned

Jun 16, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sportscare of America, PCGroup PAC ID 9032213756, 132 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sportscare of America, PC

  • Physical Therapist
  • East Hanover, NJ
  • NPI 1851484380
  Medicare reassignment Care Compare group NPD
• United Sports Care & Physical Therapy

  • Occupational Therapist
  • Cedar Knolls, NJ
  • NPI 1972881233

  Physical Therapist

  Medicare reassignment NPD
• Sportscare Institute, Inc.

  • Physical Therapist
  • Toms River, NJ
  • NPI 1275501074
  NPD (past)

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

{
    "created_epoch": "1655337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1821728320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 EAGLE ROCK AVE STE 103",
            "city": "EAST HANOVER",
            "state": "NJ",
            "postal_code": "079363167",
            "telephone_number": "973-887-9000",
            "fax_number": "973-887-3816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 EAGLE ROCK AVE STE 103",
            "city": "EAST HANOVER",
            "state": "NJ",
            "postal_code": "079363167",
            "telephone_number": "973-887-9000",
            "fax_number": "973-887-3816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMKE",
        "first_name": "WILLIAM",
        "name_suffix": "II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-16",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02095600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Muhammadali Iqbal Dinani, DMD
• Lauren S Ditaranto, LPC
• Jane Vanacore Dixon, RDN, CDCES
• Dka Medical LLC
• Michele Bauzil Dolisca, NP
• Mary Theresa Downey-Freiman, RN MSN OCN
• Dr. Joseph L. Cavallo, OD
• Nicholas Dugan
• Douglas Dzema Jr., PT, DPT
• East Hanover Chiropractic & Wellness LLC

• Physical Therapist in East Hanover, NJ
• Providers in East Hanover, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; 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.