Healthcare Provider Details

I. General information

NPI: 1457930299
Provider Name (Legal Business Name): MATTHEW BUSACCA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GARDENS AVE
POINT PLEASANT BORO NJ
08742-4043
US

IV. Provider business mailing address

1225 GARDENS AVE
POINT PLEASANT BORO NJ
08742-4043
US

V. Phone/Fax

Practice location:
  • Phone: 848-863-8420
  • Fax:
Mailing address:
  • Phone: 732-552-6253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MATTHEW BUSACCA
Title or Position: OWNER
Credential:
Phone: 732-552-6252