Provider Demographics
NPI:1164528287
Name:J&R PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:J&R PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-858-0786
Mailing Address - Street 1:415 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1504
Mailing Address - Country:US
Mailing Address - Phone:201-858-0786
Mailing Address - Fax:
Practice Address - Street 1:415 AVENUE A
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1504
Practice Address - Country:US
Practice Address - Phone:201-858-0786
Practice Address - Fax:201-858-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00517500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDE9058OtherRAILROAD MEDICARE GROUP #
NJ2523576OtherUNITED HEALTHCARE ID#
NJ094057Medicare ID - Type UnspecifiedFACILITY ID #