Healthcare Provider Details

I. General information

NPI: 1467798009
Provider Name (Legal Business Name): ADVANEDGE HAND AND PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CHARLOTTE PL
ENGLEWOOD CLIFFS NJ
07632-2615
US

IV. Provider business mailing address

120 CHARLOTTE PL
ENGLEWOOD CLIFFS NJ
07632-2615
US

V. Phone/Fax

Practice location:
  • Phone: 201-408-5448
  • Fax: 201-408-5467
Mailing address:
  • Phone: 201-408-5448
  • Fax: 201-408-5467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. JEROME G. LESACA
Title or Position: CO-OWNER
Credential:
Phone: 201-446-6440