Healthcare Provider Details

I. General information

NPI: 1750129995
Provider Name (Legal Business Name): APOSCARE MEDICAL GROUP OF NEW JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PEHLE AVE STE 200
SADDLE BROOK NJ
07663-5835
US

IV. Provider business mailing address

300 PARK AVE FL 2
NEW YORK NY
10022-7414
US

V. Phone/Fax

Practice location:
  • Phone: 855-999-2767
  • Fax:
Mailing address:
  • Phone: 205-335-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: FRED LEWIS
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 205-335-4188