Healthcare Provider Details

I. General information

NPI: 1528757317
Provider Name (Legal Business Name): BPTC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 CHESTNUT RD
WEST ORANGE NJ
07052-2632
US

IV. Provider business mailing address

43 CHESTNUT RD
WEST ORANGE NJ
07052-2632
US

V. Phone/Fax

Practice location:
  • Phone: 617-817-0456
  • Fax:
Mailing address:
  • Phone: 617-817-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA HECTOR
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 617-817-0456