Healthcare Provider Details

I. General information

NPI: 1316055056
Provider Name (Legal Business Name): PETER HASTINGS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ELM AVENUE
HACKENSACK NJ
07601
US

IV. Provider business mailing address

107 ADAMS AVE
RIVER EDGE NJ
07661-2229
US

V. Phone/Fax

Practice location:
  • Phone: 973-633-6600
  • Fax: 973-633-1100
Mailing address:
  • Phone: 201-321-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00994900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: