Provider Demographics
NPI:1336692672
Name:GARDEN STATE PHYSICAL THERAPY & SPORTS REHABILITATION
Entity Type:Organization
Organization Name:GARDEN STATE PHYSICAL THERAPY & SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARDUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-617-8000
Mailing Address - Street 1:436 ROUTE 79
Mailing Address - Street 2:SUITE 21
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-9783
Mailing Address - Country:US
Mailing Address - Phone:732-617-9000
Mailing Address - Fax:732-591-1000
Practice Address - Street 1:436 ROUTE 79
Practice Address - Street 2:SUITE 21
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-9783
Practice Address - Country:US
Practice Address - Phone:732-617-9000
Practice Address - Fax:732-591-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy