Healthcare Provider Details

I. General information

NPI: 1033105325
Provider Name (Legal Business Name): MATRIX PHYSICAL THERAPY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 KINDERKAMACK RD
ORADELL NJ
07649-2259
US

IV. Provider business mailing address

222 KINDERKAMACK RD
ORADELL NJ
07649-2259
US

V. Phone/Fax

Practice location:
  • Phone: 212-794-0820
  • Fax: 201-265-9817
Mailing address:
  • Phone: 212-794-0820
  • Fax: 201-265-9817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01179000
License Number StateNJ

VIII. Authorized Official

Name: DR. DEBRA A LIEBOWITZ
Title or Position: OWNER
Credential: PT
Phone: 212-794-0820