1801879457 NPI number — CENTER FOR ORTHOPEDIC & SPINE PHYSICALTHERAPY, PC

Table of content: (NPI 1801879457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801879457 NPI number — CENTER FOR ORTHOPEDIC & SPINE PHYSICALTHERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR ORTHOPEDIC & SPINE PHYSICALTHERAPY, PC
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:
FITNESS INTEGRATED THERAPY
Provider Other Organization Name Type Code:
3
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:
1801879457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 WOODSTONE LN
Provider Second Line Business Mailing Address:
UNIT A
Provider Business Mailing Address City Name:
BURLINGTON TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08016-4333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-721-1492
Provider Business Mailing Address Fax Number:
609-227-4423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 CADILLAC RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08016-4815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-880-0880
Provider Business Practice Location Address Fax Number:
609-227-4423
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RAMISCAL
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
SEGUI
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
609-721-1492

Provider Taxonomy Codes

  • Taxonomy code: 2251S0007X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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