Healthcare Provider Details

I. General information

NPI: 1265814487
Provider Name (Legal Business Name): BRIDGE LINX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 DEAL RD STE 103
OCEAN NJ
07712-2554
US

IV. Provider business mailing address

1001 DEAL RD STE 103
OCEAN NJ
07712-2554
US

V. Phone/Fax

Practice location:
  • Phone: 732-460-1700
  • Fax: 732-460-1722
Mailing address:
  • Phone: 732-460-1700
  • Fax: 732-460-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MASHY GUTTERMAN
Title or Position: DIRECTOR
Credential:
Phone: 732-460-1700