Provider Demographics
NPI:1407017353
Name:BCN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BCN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT
Authorized Official - Phone:908-797-2888
Mailing Address - Street 1:12 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1602
Mailing Address - Country:US
Mailing Address - Phone:908-797-2888
Mailing Address - Fax:973-379-7783
Practice Address - Street 1:12 HOLMES ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1602
Practice Address - Country:US
Practice Address - Phone:908-797-2888
Practice Address - Fax:973-379-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA06268320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077735SMMMedicare PIN