Healthcare Provider Details

I. General information

NPI: 1881069359
Provider Name (Legal Business Name): NEW JERSEY CENTER FOR RESTORATIVE BREATHING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 GORDONHURST AVE
MONTCLAIR NJ
07043-1722
US

IV. Provider business mailing address

159 GORDONHURST AVE.
MONTCLAIR NJ
07043
US

V. Phone/Fax

Practice location:
  • Phone: 917-886-1430
  • Fax:
Mailing address:
  • Phone: 917-886-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA00926600
License Number StateNJ

VIII. Authorized Official

Name: MATTHEW FIELDS
Title or Position: DIRECTOR
Credential: P.T.
Phone: 917-886-1430