Healthcare Provider Details

I. General information

NPI: 1952276792
Provider Name (Legal Business Name): NATIONAL PHYSIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 BAY AVE
OCEAN CITY NJ
08226-2568
US

IV. Provider business mailing address

PO BOX 872
AGOURA HILLS CA
91376-0872
US

V. Phone/Fax

Practice location:
  • Phone: 305-775-1076
  • Fax: 305-357-7391
Mailing address:
  • Phone: 305-775-1076
  • Fax: 305-357-7391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMES BLACK
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-606-6489