Provider Demographics
NPI:1205863883
Name:PT MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:PT MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGVINENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-797-2050
Mailing Address - Street 1:333 SYLVAN AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2705
Mailing Address - Country:US
Mailing Address - Phone:201-797-2050
Mailing Address - Fax:201-797-2052
Practice Address - Street 1:333 SYLVAN AVE STE 111
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2705
Practice Address - Country:US
Practice Address - Phone:201-568-8500
Practice Address - Fax:201-568-8518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ056893Medicare ID - Type Unspecified