1316765209 NPI number — INNOVATIVE PHYSICAL THERAPY AND FITNESS CENTER INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316765209 NPI number — INNOVATIVE PHYSICAL THERAPY AND FITNESS CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE PHYSICAL THERAPY AND FITNESS CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316765209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3562 ROUTE 27; SUITE 124
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENDALL PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-423-2069
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N HARRISON ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-3527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-423-2069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2024

Additional Information

Authorized Official

Authorized Official Last Name:
TAVARES
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
609-423-2069

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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