Healthcare Provider Details

I. General information

NPI: 1740369347
Provider Name (Legal Business Name): MADISON PT OF NEW JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 OLD HOOK RD
WESTWOOD NJ
07675-2732
US

IV. Provider business mailing address

219 RICHMOND AVE
NEW MILFORD NJ
07646-2517
US

V. Phone/Fax

Practice location:
  • Phone: 201-594-9312
  • Fax: 201-907-0404
Mailing address:
  • Phone: 201-594-9312
  • Fax: 201-907-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PERRY BONOMO
Title or Position: PRESIDENT
Credential: MSPT
Phone: 201-594-9312