Provider Demographics
NPI:1275579211
Name:NORTHEAST PHYSICAL THERAPY ASSOCIATES, PA
Entity Type:Organization
Organization Name:NORTHEAST PHYSICAL THERAPY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZZOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-985-7957
Mailing Address - Street 1:552 BLOOMFIELD AVE.
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-1338
Mailing Address - Country:US
Mailing Address - Phone:973-483-3026
Mailing Address - Fax:908-964-7744
Practice Address - Street 1:552 BLOOMFIELD AVE.
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1338
Practice Address - Country:US
Practice Address - Phone:973-483-3026
Practice Address - Fax:908-964-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00878700261QP2000X
NJ40QA01015300261QP2000X
NJ40QA01049900261QP2000X
NJ40QA01108600261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ065646M7KMedicare ID - Type UnspecifiedRICHARD RUIZ
NJ026090Medicare ID - Type UnspecifiedGROUP PROVIDER ID
NJ082375M7KMedicare ID - Type UnspecifiedGINA LU
NJ082377M7KMedicare ID - Type UnspecifiedMARY AKIAT