Healthcare Provider Details

I. General information

NPI: 1093878852
Provider Name (Legal Business Name): GENERATIONS PHYSICAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CHERRY TREE FARM ROAD
MIDDLETOWN NJ
07748-2297
US

IV. Provider business mailing address

14 CHERRY TREE FARM ROAD
MIDDLETOWN NJ
07748-2297
US

V. Phone/Fax

Practice location:
  • Phone: 732-671-3535
  • Fax: 732-671-0829
Mailing address:
  • Phone: 732-671-3535
  • Fax: 732-671-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA07722700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL H GROSSMAN
Title or Position: PRESIDENT
Credential: DC
Phone: 732-671-3535