Healthcare Provider Details

I. General information

NPI: 1932154853
Provider Name (Legal Business Name): MCRC PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PLEASANT VALLEY WAY
WEST ORANGE NJ
07052-2956
US

IV. Provider business mailing address

680 KINDERKAMACK ROAD
ORADELL NJ
07649
US

V. Phone/Fax

Practice location:
  • Phone: 973-325-3422
  • Fax: 973-325-0825
Mailing address:
  • Phone: 201-225-0100
  • Fax: 201-225-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAMIE O'NEILL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 973-376-7100