Healthcare Provider Details

I. General information

NPI: 1619420510
Provider Name (Legal Business Name): EU-PT SHOCKWAVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 BLOOMFIELD AVE SUITE 1
CALDWELL NJ
07006-4956
US

IV. Provider business mailing address

710 MILL ST H3
BELLEVILLE NJ
07109-5318
US

V. Phone/Fax

Practice location:
  • Phone: 973-968-6002
  • Fax: 973-575-9134
Mailing address:
  • Phone: 973-759-1494
  • Fax: 973-759-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD HOLSMAN
Title or Position: DIRECTOR
Credential: DPT
Phone: 973-393-5545