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General NPI Number Information
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NPI Number | 1376951889
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF NJ, LLC
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 440 OLD HOOK RD
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City | EMERSON
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State | NJ
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Zip | 07630-2302
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Country | US
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Telephone | 201-497-6752
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Fax | 201-497-6756
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Provider Business Mailing Address
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Address Line | 576 BROADHOLLOW RD
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City | MELVILLE
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State | NY
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Zip | 11747-5002
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Country | US
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Telephone | 516-321-2400
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Fax | 516-321-2401
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MS. KATHLEEN BRUSH
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Credential |
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Telephone | 718-819-6805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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