Individual provider Active NPI

Eric Ivancich, DPT

  • Physical Therapist
  • Whiting, NJ
National Provider Identifier
1972880201
Registry record updated Dec 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01423900 Issued in NJ
Practice address
67 Lacey Rd
Whiting, NJ 08759-2912
Phone
(732) 849-0700
NPI assigned
Nov 15, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2011

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 40QA01423900 NJ Primary

Addresses

Primary practice location

67 Lacey Rd
Whiting, NJ 08759-2912

Mailing address

67 Lacey Rd
Whiting, NJ 08759-2912

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120327000570 NJ Practitioner - Physical Therapist in Private Practice 9830359983 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
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)

300 Princeton Hightstown Rd
Suite 201
East Windsor, NJ 08520-1411
Phone (609) 426-4442

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01423900NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Network Inc. Physical Therapist Current Accepting new patients
Ivyrehab Network Inc Physical Therapist CurrentSince Mar 3, 2020 Accepting new patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Mar 3, 2020 Accepting new patients

Locations

849 W Bay Ave
Ste 4
Barnegat, NJ 08005
Phone (609) 660-1900

731 Lacey Rd
Ste 3
Forked River, NJ 08731
Phone (609) 242-6780

600 Mule Rd
Toms River, NJ 08757
Phone (732) 505-1300

1377 Motor Pkwy
Ste 307
Ronkonkoma, NY 11749

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": "1321315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323388800000",
    "number": "1972880201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 LACEY RD",
            "city": "WHITING",
            "state": "NJ",
            "postal_code": "087592912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 LACEY RD",
            "city": "WHITING",
            "state": "NJ",
            "postal_code": "087592912",
            "telephone_number": "732-849-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANCICH",
        "first_name": "ERIC",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-15",
        "last_updated": "2011-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01423900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiting, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; 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.