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General NPI Number Information
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NPI Number | 1518996503
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Entity Type | Organization
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Legal Business Name | ACTIVE PHYSICAL THERAPY INST., PA
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 67 BROADWAY
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407
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Country | US
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Telephone | 201-794-3223
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Fax | 201-794-8411
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Provider Business Mailing Address
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Address Line | 67 BROADWAY
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-1836
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Country | US
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Telephone | 201-794-3223
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Fax | 201-794-8411
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Authorized Official
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Title or Position | PRESIDENT
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Name | PASKO L GAZIVODA
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Credential | DPM
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Telephone | 201-794-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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