Healthcare Provider Details

I. General information

NPI: 1134342330
Provider Name (Legal Business Name): HOBOKEN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 WASHINGTON ST
HOBOKEN NJ
07030-4908
US

IV. Provider business mailing address

608 WASHINGTON ST
HOBOKEN NJ
07030-4908
US

V. Phone/Fax

Practice location:
  • Phone: 201-484-0134
  • Fax: 201-484-7123
Mailing address:
  • Phone: 201-484-0134
  • Fax: 201-484-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00875200
License Number StateNJ

VIII. Authorized Official

Name: DR. SHELLEY PALUMBO
Title or Position: CO-OWNER PHYSICAL THERAPIST
Credential: D.P.T.
Phone: 201-484-0134