Healthcare Provider Details

I. General information

NPI: 1710259643
Provider Name (Legal Business Name): PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF NJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 RIVER RD
SUMMIT NJ
07901-1450
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5002
US

V. Phone/Fax

Practice location:
  • Phone: 908-277-0800
  • Fax: 908-277-0808
Mailing address:
  • Phone: 631-359-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: HELEN AGRELO
Title or Position: EXECUTIVE DIRECTOR OF BUSINESS OPS
Credential:
Phone: 516-321-2424