1598889479 NPI number — OLD BRIDGE CENTER OF PHYSICAL THERAPY INC

Table of content: (NPI 1598889479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598889479 NPI number — OLD BRIDGE CENTER OF PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLD BRIDGE CENTER OF PHYSICAL THERAPY 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:
1598889479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 PERRINE RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
OLD BRIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08857-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-525-1133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 PERRINE RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
OLD BRIDGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08857-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-525-1133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MISTRY
Authorized Official First Name:
BHAVESH
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
732-525-1133

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA00999300 , 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)





Copyright © 2007-2024 www.npivalidator.com