Provider Demographics
NPI:1346482726
Name:ADVANTAGE PHYSICAL THERAPY OF NEW JERSEY, LLC
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOHN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-455-7121
Mailing Address - Street 1:95 MADISON AVE
Mailing Address - Street 2:SUITE A07
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6092
Mailing Address - Country:US
Mailing Address - Phone:973-455-7121
Mailing Address - Fax:973-455-1895
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:SUITE A07
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6092
Practice Address - Country:US
Practice Address - Phone:973-455-7121
Practice Address - Fax:973-455-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00256000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ064372Medicare PIN