MEDICARE: PLATINUM PHYSICAL THERAPY & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization	38MC00672600	NJ

General Provider Information

NPI Number	:	1043762065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATINUM PHYSICAL THERAPY & WELLNESS

Provider Business Mailing Address
First Line	:	809 ROUTE 36
Second Line	:
City	:	UNION BEACH
State	:	NJ
Zip	:	07735-3366
Country	:	US
Telephone Number	:	732-497-0930
Fax Number	:	732-497-0932

Provider Business Practice Location Address
First Line	:	809 HIGHWAY 36
Second Line	:
City	:	UNION BEACH
State	:	NJ
Zip	:	07735-3366
Country	:	US
Telephone Number	:	732-497-0930
Fax Number	:	732-497-0932

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. JERRY GOLDENBERG
Credential	:	D.C.
Telephone Number	:	732-442-5542

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	10/25/2016

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Directions to “PLATINUM PHYSICAL THERAPY & WELLNESS ” Practice Location

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