Provider Demographics
NPI:1477853547
Name:ACE PHYSICAL THERAPY AND WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:ACE PHYSICAL THERAPY AND WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:UBALDO
Authorized Official - Last Name:RIGOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:908-820-0600
Mailing Address - Street 1:171 ELMORA AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1169
Mailing Address - Country:US
Mailing Address - Phone:908-820-0600
Mailing Address - Fax:908-820-0601
Practice Address - Street 1:171 ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1169
Practice Address - Country:US
Practice Address - Phone:908-820-0600
Practice Address - Fax:908-820-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00610400261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJR2594108408652OtherNEW JERSEY STATE DRIVER'S LICENSE