Healthcare Provider Details

I. General information

NPI: 1629011317
Provider Name (Legal Business Name): GARY ALLAN SHIFFMAN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMERCENTER STATE HWY. 17 SOUTH SUITE G
MAHWAH NJ
07430
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD STE 220
RED BANK NJ
07701-5792
US

V. Phone/Fax

Practice location:
  • Phone: 201-529-8322
  • Fax: 201-529-8377
Mailing address:
  • Phone: 732-807-0877
  • Fax: 201-751-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number40QA00333400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA00333400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: