Healthcare Provider Details

I. General information

NPI: 1619061074
Provider Name (Legal Business Name): BENJAMIN MEIR BURTON P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 NEWARK POMPTON TPKE
RIVERDALE NJ
07457-1426
US

IV. Provider business mailing address

69 NEWARK POMPTON TPKE
RIVERDALE NJ
07457-1426
US

V. Phone/Fax

Practice location:
  • Phone: 973-248-8111
  • Fax: 973-248-8113
Mailing address:
  • Phone: 973-248-8111
  • Fax: 973-248-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number40QA00621100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA00621100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: