Healthcare Provider Details

I. General information

NPI: 1811340243
Provider Name (Legal Business Name): ALPHA ONE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 KENNEDY BLVD
JERSEY CITY NJ
07306-3416
US

IV. Provider business mailing address

3600 BERGENLINE AVE STE 8
UNION CITY NJ
07087-7900
US

V. Phone/Fax

Practice location:
  • Phone: 917-574-5334
  • Fax: 718-333-1398
Mailing address:
  • Phone: 917-574-5334
  • Fax: 718-333-1398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: OMAR AHMED
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 917-574-5334