Provider Demographics
NPI:1467798009
Name:ADVANEDGE HAND AND PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ADVANEDGE HAND AND PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:G
Authorized Official - Last Name:LESACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-446-6440
Mailing Address - Street 1:120 CHARLOTTE PL
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2615
Mailing Address - Country:US
Mailing Address - Phone:201-408-5448
Mailing Address - Fax:201-408-5467
Practice Address - Street 1:120 CHARLOTTE PL
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2615
Practice Address - Country:US
Practice Address - Phone:201-408-5448
Practice Address - Fax:201-408-5467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-01
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QP2000X, 335E00000X
261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No335E00000XSuppliersProsthetic/Orthotic Supplier