Individual provider Active NPI

Jacqueline Gallo

  • Physical Therapist
  • Franklin Lakes, NJ
National Provider Identifier
1932833407
Registry record updated Jul 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA02085700 Issued in NJ
Practice address
795 Franklin Ave
Franklin Lakes, NJ 07417-1368
Phone
(201) 847-8585
NPI assigned
Jul 12, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2022

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 40QA02085700 NJ Primary

Addresses

Primary practice location

795 Franklin Ave
Franklin Lakes, NJ 07417-1368

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224

Other practice location 1

263 Beechwood Rd
Oradell, NJ 07649-1807
Phone (201) 835-3522

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221113000029 NJ Practitioner - Physical Therapist in Private Practice 4385011824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
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)

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA02085700NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Jul 26, 2022 Accepting new patients
Ivyrehab Network Inc. Physical Therapist CurrentSince Jul 26, 2022 Accepting new patients

Locations

795 Franklin Ave
Franklin Lks, NJ 07417
Phone (201) 639-6620

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

1311 Mamaroneck Ave
Ste 140
White Plains, NY 10605
Phone (914) 265-4838

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": "1657584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1932833407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 FRANKLIN AVE",
            "city": "FRANKLIN LAKES",
            "state": "NJ",
            "postal_code": "074171368",
            "telephone_number": "201-847-8585"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "263 Beechwood Rd",
            "address_purpose": "LOCATION",
            "city": "Oradell",
            "state": "NJ",
            "postal_code": "076491807",
            "country_code": "US",
            "telephone_number": "201-835-3522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GALLO",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-12",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02085700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Franklin Lakes, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.