1467617795 NPI number — MONTVILLE PHYSICAL THERAPY, PC

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 1467617795 NPI number — MONTVILLE PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTVILLE PHYSICAL THERAPY, 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:
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:
1467617795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 CHANGEBRIDGE RD
Provider Second Line Business Mailing Address:
EAST BUILDING, SUITE F
Provider Business Mailing Address City Name:
MONTVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07045-8947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-917-3134
Provider Business Mailing Address Fax Number:
973-917-3138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CHANGEBRIDGE RD
Provider Second Line Business Practice Location Address:
EAST BUILDING, SUITE F
Provider Business Practice Location Address City Name:
MONTVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07045-8947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-917-3134
Provider Business Practice Location Address Fax Number:
973-917-3138
Provider Enumeration Date:
07/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BURTON
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
MEIR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-917-3134

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com