Provider Demographics
NPI:1346428299
Name:GMD PHYSICAL & OCCUPATIONAL THERAPY, LLC
Entity Type:Organization
Organization Name:GMD PHYSICAL & OCCUPATIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DERSOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OTR/L
Authorized Official - Phone:866-613-6801
Mailing Address - Street 1:324 DONALDSON ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2521
Mailing Address - Country:US
Mailing Address - Phone:866-613-6801
Mailing Address - Fax:866-734-1463
Practice Address - Street 1:324 DONALDSON ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2521
Practice Address - Country:US
Practice Address - Phone:866-613-6801
Practice Address - Fax:866-734-1463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-02
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017930225100000X
NJ40QA01130400225100000X
NY012347225X00000X
NJ46TR00382200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty