Provider Demographics
NPI:1407917214
Name:PLATZ, ELMER R (PT)
Entity Type:Individual
Prefix:MR
First Name:ELMER
Middle Name:R
Last Name:PLATZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 STATE RT 515
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3027
Mailing Address - Country:US
Mailing Address - Phone:973-764-6136
Mailing Address - Fax:973-764-4515
Practice Address - Street 1:418 STATE RT 515
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-3027
Practice Address - Country:US
Practice Address - Phone:973-764-6136
Practice Address - Fax:973-764-4515
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00133700225100000X
NY004018-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYEP0Q554810OtherEMPIRE BCBS PROVIDER NO.
NJ222054583OtherTAX IDENTIFICATION NUMBER
NJ222054583OtherTAX IDENTIFICATION NUMBER
NJ316634Medicare Oscar/Certification
NYP00175122Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
NYEP0Q554810OtherEMPIRE BCBS PROVIDER NO.