1831513332 NPI number — 176 RT 9 PT LLC

Table of content: (NPI 1831513332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831513332 NPI number — 176 RT 9 PT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
176 RT 9 PT 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:
TLC PHYSICAL 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:
1831513332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 RTE 9
Provider Second Line Business Mailing Address:
STE# 204
Provider Business Mailing Address City Name:
ENGLISHTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07726-9218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-816-6500
Provider Business Mailing Address Fax Number:
718-816-4677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 ROUTE 9 STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLISHTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07726-9220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-816-6500
Provider Business Practice Location Address Fax Number:
718-816-4677
Provider Enumeration Date:
02/05/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAMENDOLA
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-816-6500

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  40QA01318300 , 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)