Provider Demographics
NPI:1093432783
Name:HACKETTSTOWN-GORDON, LLC
Entity Type:Organization
Organization Name:HACKETTSTOWN-GORDON, LLC
Other - Org Name:FYZICAL THERAPY & BALANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:DIPAOLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:908-612-9151
Mailing Address - Street 1:920 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2016
Mailing Address - Country:US
Mailing Address - Phone:908-612-9151
Mailing Address - Fax:
Practice Address - Street 1:470 SCHOOLEYS MOUNTAIN RD STE 9
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4238
Practice Address - Country:US
Practice Address - Phone:908-520-2346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIPAOLO PHYSICAL THERAPY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-24
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1942573746OtherEILEEN INCIONG