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General NPI Number Information
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NPI Number | 1629426093
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Entity Type | Organization
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Legal Business Name | NORTH JERSEY PHYSICAL THERAPY & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 1373 BROAD ST STE 301
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City | CLIFTON
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State | NJ
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Zip | 07013-4200
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Country | US
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Telephone | 973-340-1940
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Fax | 973-340-1947
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Provider Business Mailing Address
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Address Line | 1373 BROAD ST STE 301
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City | CLIFTON
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State | NJ
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Zip | 07013-4200
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Country | US
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Telephone | 973-340-1940
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Fax | 973-340-1947
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL RUSSONELLA
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Credential |
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Telephone | 973-340-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NJ
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