Montclair State University

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

MONTCLAIR STATE UNIVERSITY

Doing business as

MSU Ben Samuels Children's Center
Montclair State University-Demonstration Program

Practice address

80 Clove Rd
Little Falls, NJ 07424-2102

Phone

(973) 655-7991

NPI assigned

Apr 6, 2022

Organization subpart

No

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

Authorized official

Name

Lyudmyla Yakubov

Title

Director

Phone

(973) 655-7587

Specialties & licenses 1

Addresses

Other names 2

• MSU Ben Samuels Children's Center Doing business as
• Montclair State University-Demonstration Program Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather Dibble, SLP

  • Speech-Language Pathologist
  • Little Falls, NJ
  • NPI 1205560018
  NPD

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

{
    "created_epoch": "1649203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649203200000",
    "number": "1932840691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 NORMAL AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070431624",
            "telephone_number": "973-655-7991",
            "fax_number": "973-655-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 CLOVE RD",
            "city": "LITTLE FALLS",
            "state": "NJ",
            "postal_code": "074242102",
            "telephone_number": "973-655-7991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTCLAIR STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-06",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "YAKUBOV",
        "authorized_official_first_name": "LYUDMYLA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "973-655-7587"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSU Ben Samuels Children's Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Montclair State University-Demonstration Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mindful Perspectives
• Samantha Emily Mirman
• Amita Mistry
• Tracy Marie Mitchell, LCSW
• Robert Carl Mollica, MS OTR
• Kevin Moran, RN
• Susan Morcos
• Mount Freedom Chiropractic
• Marilou Naklicki
• Nancy Lentine D.O., PA

• Physical Therapist in Little Falls, NJ
• Providers in Little Falls, 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 Apr 6, 2022; 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.