Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ajay S Mampilly

Individual provider Physical Therapy Assistant · NPI 1073947321

Ajay S Mampilly is a Physical Therapist in Private Practice in Emerson, New Jersey. Qualified in 2018, 8 years ago. Practices with Jag-One Physical Therapy LLC, a 328-clinician group and accepts Medicare assignment. Licensed in New Jersey.

Years since qualifying
8
Licensed in
NJ
In the registry since
2013

Practice location Address checks out

100 Kinderkamack Rd
Emerson, NJ 07630-1828
Phone: (888) 493-6415
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 40QB00300600 (NJ)

Record details

NPI number1073947321
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedAugust 22, 2013
Last updated in NPPESAugust 22, 2013
Mailing address67 Rollinson St, West Orange, NJ 07052-4625

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Jag-One Physical Therapy Llc — 328 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Emerson