MR. SHANE FAMILLE (NPI# 1689781593) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689781593 |
| Entity Type | Individual |
| Full Name | MR. SHANE FAMILLE |
| Credential | PT, ATC |
| Practice Address |
17 11th Ave Glendora NJ 08029-1333 |
| Practice Telephone | 8562160047 |
| Practice Fax Number | 8564279314 |
| Mailing Telephone | 8562160047 |
| Mailing Fax Number | 8564279314 |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2010-02-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251S0007X |
Physical Therapist Specialization: Sports |
40QA01317800 | NJ | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
25MT00125600 | NJ | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
17 11TH AVE |
| City | GLENDORA |
| State | NJ |
| Zip Code | 08029-1333 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932273711 | Bruce Kerensky | Dentist | 120 E Evesham Road, Glendora, NJ 08029 | 2006-11-20 |
| 1700891694 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1301 Black Horse Pike, Glendora, NJ 08029 | 2006-07-29 |
| 1295115996 | Aja Brianna Corchado | Specialist/Technologist | 104 Bozarth Ave, Glendora, NJ 08029-1241 | 2015-06-08 |
| 1841481918 | Gail Judith Hallof | Nurse Anesthetist, Certified Registered | 204 W Evesham Rd, Glendora, NJ 08029-1246 | 2007-08-05 |
| 1770731697 | Roderick Joseph Sandiego | Registered Nurse | 517 N Hildebrand Ave, Glendora, NJ 08029-1276 | 2008-09-04 |
| 1114530433 | Quanhao Fu | Pharmacist | 1301 Black Horse Pike, Glendora, NJ 08029-1307 | 2020-08-26 |
| 1558902635 | Zoya Kakar | Pharmacist | 1301 Black Horse Pike, Glendora, NJ 08029-1307 | 2019-10-01 |
| 1326315631 | Mona Patel | Pharmacist | 1301 Black Horse Pike, Glendora, NJ 08029-1307 | 2011-11-30 |
| 1598048761 | Ty Lam | Pharmacist | 1301 Black Horse Pike, Glendora, NJ 08029-1307 | 2011-09-23 |
| 1285917609 | Valerie Anne Mcguigan | Pharmacist | 1301 Black Horse Pike, Glendora, NJ 08029-1307 | 2011-09-21 |
| Find all providers in zip 08029 | ||||
| Taxonomy Code | 2251S0007X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Sports |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598363582 | Rufus Zachary Hay | Physical Therapist | 1609 11th Ave, Toms River, NJ 08757-2038 | 2020-10-13 |
| 1497376297 | Nicholas Mckaba | Physical Therapist | 33 Ascot Dr, Long Valley, NJ 07853-3660 | 2020-05-03 |
| 1437624269 | Heather Minue | Physical Therapist | 38 Danbury Rd, Tinton Falls, NJ 07753-7918 | 2018-10-08 |
| 1962925412 | Provere Physical Therapy - Paramus LLC | Physical Therapist | 407 Sette Dr Bldg E, Paramus, NJ 07652-2940 | 2017-07-17 |
| 1477804748 | Joseph B. Peragine | Physical Therapist | 144 Princeton Oval, Freehold, NJ 07728-5336 | 2012-09-27 |
| 1235431586 | Harold Alaan | Physical Therapist | 239 English Pl, Basking Ridge, NJ 07920-2799 | 2010-11-18 |
| 1154595197 | Sports Medicine Center of Bergen, Pa | Physical Therapist | 136 Hopper Ave., Waldwick, NJ 07463 | 2008-04-22 |
| 1619061074 | Benjamin Meir Burton | Physical Therapist | 69 Newark Pompton Tpke, Riverdale, NJ 07457-1426 | 2006-10-03 |
| 1952408296 | Rodolfo Chua Jr. | Physical Therapist | 575 High Mountain Rd, North Haledon, NJ 07508-2662 | 2006-09-20 |
| 1093731036 | Thomas Matthew Donofrio | Physical Therapist | 595 Wildwood Rd W, Northvale, NJ 07647 | 2006-07-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.