Healthcare Provider Details

I. General information

NPI: 1629136288
Provider Name (Legal Business Name): BERGENFIELD PHYSICAL THERAPY AND REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 BLOOMFIELD AVE SUITE C
BLOOMFIELD NJ
07003-5902
US

IV. Provider business mailing address

135 BLOOMFIELD AVE SUITE C
BLOOMFIELD NJ
07003-5902
US

V. Phone/Fax

Practice location:
  • Phone: 973-429-0045
  • Fax: 973-429-8161
Mailing address:
  • Phone: 973-429-0045
  • Fax: 973-429-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01065200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier064850SGL
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerJOSE ANMOSEL LOZADA, PT
# 2
Identifier076474SGL
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerLUNINGNING LOZADA, PT

VIII. Authorized Official

Name: MRS. LUNINGNING TUAZON LOZADA
Title or Position: PT
Credential: PT
Phone: 973-979-5283