1346482726 NPI number — ADVANTAGE PHYSICAL THERAPY OF NEW JERSEY, LLC

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 1346482726 NPI number — ADVANTAGE PHYSICAL THERAPY OF NEW JERSEY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANTAGE PHYSICAL THERAPY OF NEW JERSEY, LLC
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:
1346482726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 MADISON AVE
Provider Second Line Business Mailing Address:
SUITE A07
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07960-6092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-455-7121
Provider Business Mailing Address Fax Number:
973-455-1895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE A07
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-6092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-455-7121
Provider Business Practice Location Address Fax Number:
973-455-1895
Provider Enumeration Date:
03/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KOHN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-455-7121

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA00256000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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