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General NPI Number Information
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NPI Number | 1043711203
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Entity Type | Organization
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Legal Business Name | PANDA PHYSICAL MEDICINE LLC
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 142 HIGHWAY 35 STE 107
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City | EATONTOWN
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State | NJ
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Zip | 07724-1864
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Country | US
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Telephone | 732-898-3040
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Fax | 732-531-1200
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Provider Business Mailing Address
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Address Line | 904 DEAL RD APT 12
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City | OCEAN
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State | NJ
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Zip | 07712-3443
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Country | US
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Telephone | 732-455-1375
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Fax | 732-230-7680
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | CHARLES A FERRANTE
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Credential | DC
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Telephone | 732-455-1375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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