Healthcare Provider Details

I. General information

NPI: 1164688750
Provider Name (Legal Business Name): THERAPY CENTER OF NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2008
Last Update Date: 08/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 GRAND AVE
HACKENSACK NJ
07601-4705
US

IV. Provider business mailing address

453 GLENWOOD AVE
TEANECK NJ
07666-6405
US

V. Phone/Fax

Practice location:
  • Phone: 201-820-3343
  • Fax:
Mailing address:
  • Phone: 201-266-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01048000
License Number StateNJ

VIII. Authorized Official

Name: EMERSON M MATEO
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 201-478-0394