=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073752234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | F.P.T. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2009
-----------------------------------------------------
Last Update Date | 02/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 GROVE ST
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07042-4209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-509-8464
-----------------------------------------------------
Fax | 815-301-2780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 GROVE ST
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07042-4209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-509-8464
-----------------------------------------------------
Fax | 815-301-2780
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. DAVID L FROME
-----------------------------------------------------
Credential | P.T., LIC. ACU.
-----------------------------------------------------
Telephone | 973-509-8464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | 25MZ00042600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | 002980-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | 008268-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | 40QA00506300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------