Healthcare Provider Details

I. General information

NPI: 1609002591
Provider Name (Legal Business Name): ADVANCED PHYSICAL THERAPY & SPINAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 MARKET ST SUITE B2
SADDLE BROOK NJ
07663-5300
US

IV. Provider business mailing address

383 MARKET ST SUITE B2
SADDLE BROOK NJ
07663-5300
US

V. Phone/Fax

Practice location:
  • Phone: 201-712-0009
  • Fax: 201-712-0040
Mailing address:
  • Phone: 201-712-0009
  • Fax: 201-712-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00559000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL T. POGORELEC
Title or Position: OWNER
Credential: D.C.
Phone: 201-712-0009