Healthcare Provider Details

I. General information

NPI: 1770378697
Provider Name (Legal Business Name): ROCK LODGE VENTURES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

470 SCHOOLEYS MOUNTAIN RD STE 9
HACKETTSTOWN NJ
07840-4238
US

IV. Provider business mailing address

470 SCHOOLEYS MOUNTAIN RD STE 9
HACKETTSTOWN NJ
07840-4238
US

V. Phone/Fax

Practice location:
  • Phone: 908-520-2346
  • Fax:
Mailing address:
  • Phone: 908-520-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES R ANKNER
Title or Position: OWNER
Credential:
Phone: 908-520-2346