Provider Demographics
NPI:1487678538
Name:OPTIMUM ORTHOPEDICS PHYSICAL THERAPY AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:OPTIMUM ORTHOPEDICS PHYSICAL THERAPY AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-746-2424
Mailing Address - Street 1:70 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1216
Mailing Address - Country:US
Mailing Address - Phone:201-933-9959
Mailing Address - Fax:201-933-9958
Practice Address - Street 1:70 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1216
Practice Address - Country:US
Practice Address - Phone:201-933-9959
Practice Address - Fax:201-933-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ038413Medicare PIN