Healthcare Provider Details

I. General information

NPI: 1528480266
Provider Name (Legal Business Name): PHYSICAL MEDICINE & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 PROFESSIONAL VIEW DR
FREEHOLD NJ
07728-7902
US

IV. Provider business mailing address

103 PROFESSIONAL VIEW DR
FREEHOLD NJ
07728-7902
US

V. Phone/Fax

Practice location:
  • Phone: 732-780-2273
  • Fax: 732-780-3752
Mailing address:
  • Phone: 732-780-2273
  • Fax: 732-780-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00556200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00059300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01422300
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID HOROWITZ
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 732-780-2273