Healthcare Provider Details

I. General information

NPI: 1356312615
Provider Name (Legal Business Name): HOBOKEN PHYSICAL THERAPY AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GRAND ST
HOBOKEN NJ
07030-2808
US

IV. Provider business mailing address

701 GRAND ST
HOBOKEN NJ
07030-2808
US

V. Phone/Fax

Practice location:
  • Phone: 201-792-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA00991200
License Number StateNJ

VIII. Authorized Official

Name: MICHAEL S RUSSO
Title or Position: OWNER
Credential: M.S.P.T.
Phone: 201-792-5300