Healthcare Provider Details

I. General information

NPI: 1629897426
Provider Name (Legal Business Name): 505 PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 ROUTE 18
E BRUNSWICK NJ
08816-2468
US

IV. Provider business mailing address

505 ROUTE 18
E BRUNSWICK NJ
08816-2468
US

V. Phone/Fax

Practice location:
  • Phone: 201-936-0170
  • Fax: 908-248-8466
Mailing address:
  • Phone: 201-936-0170
  • Fax: 908-248-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PEGGY BAFFOE
Title or Position: ADMIN
Credential:
Phone: 201-936-0170