Provider Demographics
NPI:1164688750
Name:THERAPY CENTER OF NEW JERSEY
Entity Type:Organization
Organization Name:THERAPY CENTER OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMERSON
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-478-0394
Mailing Address - Street 1:453 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6405
Mailing Address - Country:US
Mailing Address - Phone:201-266-0414
Mailing Address - Fax:
Practice Address - Street 1:180 GRAND AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4705
Practice Address - Country:US
Practice Address - Phone:201-820-3343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01048000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy