Provider Demographics
NPI:1043393085
Name:ADVANCED PHYSICAL MEDICINE CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-945-1156
Mailing Address - Street 1:222 BERGEN BLVD
Mailing Address - Street 2:STE 8
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022
Mailing Address - Country:US
Mailing Address - Phone:201-945-1156
Mailing Address - Fax:201-945-0012
Practice Address - Street 1:222 BERGEN BLVD
Practice Address - Street 2:STE 8
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022
Practice Address - Country:US
Practice Address - Phone:201-945-1156
Practice Address - Fax:201-945-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
066159Medicare PIN