Healthcare Provider Details

I. General information

NPI: 1538038716
Provider Name (Legal Business Name): ADVANCED PHYSICAL MEDICINE CENTER OF FAIRVIEW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 BERGEN BLVD STE 8
FAIRVIEW NJ
07022-1300
US

IV. Provider business mailing address

222 BERGEN BLVD STE 8
FAIRVIEW NJ
07022-1300
US

V. Phone/Fax

Practice location:
  • Phone: 201-945-1156
  • Fax: 201-945-0012
Mailing address:
  • Phone: 201-945-1156
  • Fax: 201-945-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID BERK
Title or Position: OWNER
Credential: DC
Phone: 201-945-1156