Jersey Rehab PA PC – Physical Medicine & Rehabilitation Physician, NPI 1629005012
Physical Medicine & Rehabilitation Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Jersey Rehab PA PC
15, Newark Avenue, Nutley, Essex County, New Jersey, 07110, United States
BELLEVILLE, NJ 071091123
Phone: (973) 482-1614
Fax: (973) 485-6126
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2011-08-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-05-31 (12 days ago).
Enrollment records
3
Earliest due date
2026-05-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040830000390 | O | Clinic/Group Practice | NJ | TBD |
| O20090508000547 | O | Clinic/Group Practice | NY | TBD |
| O20110819000430 | O | Physician - Physical And Rehabilitation | NJ | 2026-05-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 07109)
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