Provider Demographics
NPI:1114336138
Name:ADVANCED PHYSICAL MEDICINE & REHABILITATION, LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REIZIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:732-894-9200
Mailing Address - Street 1:1719 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE COMO
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3097
Mailing Address - Country:US
Mailing Address - Phone:732-894-9200
Mailing Address - Fax:732-894-9202
Practice Address - Street 1:1719 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE COMO
Practice Address - State:NJ
Practice Address - Zip Code:07719-3097
Practice Address - Country:US
Practice Address - Phone:732-894-9200
Practice Address - Fax:732-894-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00090400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty