Healthcare Provider Details

I. General information

NPI: 1710500152
Provider Name (Legal Business Name): ETHOS PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 MAIN ST STE 2S
HACKENSACK NJ
07601-4930
US

IV. Provider business mailing address

873 MAIN ST STE 2S
HACKENSACK NJ
07601-4930
US

V. Phone/Fax

Practice location:
  • Phone: 201-290-4826
  • Fax: 201-643-6195
Mailing address:
  • Phone: 201-290-4826
  • Fax: 201-643-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOHN B PUZIO
Title or Position: OWNER
Credential: PT, DPT, OCS
Phone: 201-290-4826