1205168457 NPI number — GOLDMAN PHYSICAL THERAPY, LLC

Table of content: (NPI 1205168457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205168457 NPI number — GOLDMAN PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDMAN PHYSICAL THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205168457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 NORDHOFF PL FL 2
Provider Second Line Business Mailing Address:
THE GYM
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07631-4811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-567-9399
Provider Business Mailing Address Fax Number:
201-567-9394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 NORDHOFF PL FL 2
Provider Second Line Business Practice Location Address:
THE GYM
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631-4811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-567-9399
Provider Business Practice Location Address Fax Number:
201-567-9394
Provider Enumeration Date:
02/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
646-321-2639

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA01155800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZL5614 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: G4194239 . This is a "OXFORD -OUT OF NETWRK" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 40QA01155800 . This is a "NJ LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P4064332 . This is a "OXFORD HEALTH - OON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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