NPIMap

Organization Active NPI

Eastern Shore Physical Therapy

  • Physical Therapist
  • Linwood, NJ
National Provider Identifier
1992838643
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA00872300 Issued in NJ
Legal business name
EASTERN SHORE PHYSICAL THERAPY
Practice address
1999 New Rd
Suite C
Linwood, NJ 08221-1060
Phone
(609) 601-6140
Fax
(609) 601-6141
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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

Authorized official

Name
Joseph Thomas Derosa, PTNPI 1790823318
Title
President
Phone
(609) 601-6140

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 40QA00872300 NJ Primary

Addresses

Primary practice location

1999 New Rd
Suite C
Linwood, NJ 08221-1060

Mailing address

PO Box 751
Northfield, NJ 08225-0751
Phone (609) 601-6140

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051123000169 NJ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9830117043 Receives reassigned benefits from 5 practitioners
Practice locations: Linwood, NJ

National Provider Directory

National Provider Directory

Locations

1999 New Rd
Ste C
Linwood, NJ 08221
Phone (609) 601-6140

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662940800000",
    "number": "1992838643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751",
            "city": "NORTHFIELD",
            "state": "NJ",
            "postal_code": "082250751",
            "telephone_number": "609-601-6140",
            "fax_number": "609-601-6141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1999 NEW RD",
            "address_2": "SUITE C",
            "city": "LINWOOD",
            "state": "NJ",
            "postal_code": "082211060",
            "telephone_number": "609-601-6140",
            "fax_number": "609-601-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A",
        "authorized_official_last_name": "DEROSA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "609-601-6140",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00872300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Linwood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.