Provider Demographics
NPI:1013231240
Name:PEAK PERFORMANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PEAK PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SARACENO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-344-0012
Mailing Address - Street 1:250 MCWHORTER ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-6023
Mailing Address - Country:US
Mailing Address - Phone:973-344-0012
Mailing Address - Fax:973-344-0898
Practice Address - Street 1:250 MCWHORTER ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-6023
Practice Address - Country:US
Practice Address - Phone:973-344-0012
Practice Address - Fax:973-344-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00613400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty