Healthcare Provider Details

I. General information

NPI: 1629130794
Provider Name (Legal Business Name): ALEX SEKIRIN MPT, ACSM-CEP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ROUTE 9 NORTH SUITE 202
WOODBRIDGE NJ
07095
US

IV. Provider business mailing address

7 PALOMINO DR
OLD BRIDGE NJ
08857-3622
US

V. Phone/Fax

Practice location:
  • Phone: 732-750-4900
  • Fax: 732-750-4902
Mailing address:
  • Phone: 917-848-3858
  • Fax: 732-750-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number40QA01274300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01274300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: