Provider Demographics
NPI:1043762065
Name:PLATINUM PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:PLATINUM PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-442-5542
Mailing Address - Street 1:809 ROUTE 36
Mailing Address - Street 2:
Mailing Address - City:UNION BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-3366
Mailing Address - Country:US
Mailing Address - Phone:732-497-0930
Mailing Address - Fax:732-497-0932
Practice Address - Street 1:809 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:UNION BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07735-3366
Practice Address - Country:US
Practice Address - Phone:732-497-0930
Practice Address - Fax:732-497-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00672600302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization