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

Dr. Ivan Tam, DPT

Individual provider Physical Therapist · NPI 1104581248

Dr. Ivan Tam, DPT is a Physical Therapist in Private Practice in Nanuet, New York. Qualified in 2021, 5 years ago. Practices with Ivyrehab Network Inc, a 653-clinician group and accepts Medicare assignment. Licensed in Massachusetts, New Jersey and New York.

Years since qualifying
5
Licensed in
MA, NJ, NY
In the registry since
2021
Specialties on file
3
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

412 Market St
Nanuet, NY 10954-2744
Phone: (718) 552-7267
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 047376 (NY)
Physical Therapist Taxonomy 225100000X · Licence 40QA02326900 (NJ)
Physical Therapist Taxonomy 225100000X · Licence 26504 (MA)

Record details

NPI number1104581248
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedNovember 3, 2021
Last updated in NPPESSeptember 26, 2025
Certification dateSeptember 26, 2025
Mailing address1831 Shore Pkwy, Brooklyn, NY 11214-6619

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Ivyrehab Network Inc — 653 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Nanuet