Provider Demographics
NPI:1093878852
Name:GENERATIONS PHYSICAL MEDICINE LLC
Entity Type:Organization
Organization Name:GENERATIONS PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-671-3535
Mailing Address - Street 1:14 CHERRY TREE FARM ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2297
Mailing Address - Country:US
Mailing Address - Phone:732-671-3535
Mailing Address - Fax:732-671-0829
Practice Address - Street 1:14 CHERRY TREE FARM ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2297
Practice Address - Country:US
Practice Address - Phone:732-671-3535
Practice Address - Fax:732-671-0829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 225100000X
NJ25MA07722700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty