Basic Information
| Provider Information | |||||||||
| NPI: | 1669421400 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JERSEY PHYSICAL THERAPY ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3228 STATE ROUTE 27 STE 2A | ||||||||
| Address2: | |||||||||
| City: | KENDALL PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088241524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322970032 | ||||||||
| FaxNumber: | 7322970558 | ||||||||
| Practice Location | |||||||||
| Address1: | 3228 STATE ROUTE 27 | ||||||||
| Address2: | |||||||||
| City: | KENDALL PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088241445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322970032 | ||||||||
| FaxNumber: | 7322970558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | RUBENSTEIN | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6097855386 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT,DPT | ||||||||
| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | XXXXXXXXX | 01 | TAX ID NUMBER | OTHER |