Individual provider Active NPI

Will Stanaback, PT, DPT

  • Orthopedic Physical Therapist
  • Florham Park, NJ
National Provider Identifier
1962998427
Registry record updated Jul 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
40QA01792500 Issued in NJ
Practice address
140 Park Ave
Florham Park, NJ 07932-1049
Phone
(908) 277-8967
NPI assigned
Jul 9, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X 40QA01792500 NJ Primary

Addresses

Primary practice location

140 Park Ave
Florham Park, NJ 07932-1049

Mailing address

140 Park Ave
Florham Park, NJ 07932-1049
Phone (908) 277-8967

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180921000750 NJ Practitioner - Physical Therapist in Private Practice 7214288760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group PAGroup PAC ID 5395642276, 1,204 clinicians

Practice addresses (Care Compare)

1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 273-4300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01792500NJMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group PA Multi-Specialty CurrentSince Aug 6, 2018 Accepting new patients
Summit Medical Group PA CurrentSince Aug 6, 2018 Accepting new patients
Summit Medical Group, Inc Multi-Specialty Past Accepting new patients

Locations

1 Diamond Hill Rd
Berkeley Heights, NJ 07922
Phone (908) 277-8868

140 Park Ave
Florham Park, NJ 07932
Phone (973) 285-7613

150 Floral Ave
New Providence, NJ 07974
Phone (908) 588-3890

Interoperability endpoints

  • Direct secure messaging: william.stanaback.1@2983.direct.athenahealth.com

Organizations & group practices 3

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": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531094400000",
    "number": "1962998427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 PARK AVE",
            "city": "FLORHAM PARK",
            "state": "NJ",
            "postal_code": "079321049",
            "telephone_number": "908-277-8967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 PARK AVE",
            "city": "FLORHAM PARK",
            "state": "NJ",
            "postal_code": "079321049",
            "telephone_number": "908-277-8967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANABACK",
        "first_name": "WILL",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-09",
        "last_updated": "2018-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NJ",
            "license": "40QA01792500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florham Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; 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.