Provider Demographics
NPI:1407517386
Name:FTX NEW JERSEY LLC
Entity Type:Organization
Organization Name:FTX NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYED
Authorized Official - Middle Name:HESSAM
Authorized Official - Last Name:KHATAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-995-0136
Mailing Address - Street 1:7815 NW BEACON SQUARE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1345
Mailing Address - Country:US
Mailing Address - Phone:561-995-0136
Mailing Address - Fax:
Practice Address - Street 1:3817 CROSSWICKS-HAMILTON SQ RD
Practice Address - Street 2:UNIT G, SUITE 128
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691
Practice Address - Country:US
Practice Address - Phone:561-995-0136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty