Provider Demographics
NPI:1508064858
Name:PT ADVANTAGE
Entity Type:Organization
Organization Name:PT ADVANTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGA-CABUNAG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-738-1366
Mailing Address - Street 1:931 AMBOY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2818
Mailing Address - Country:US
Mailing Address - Phone:732-738-1366
Mailing Address - Fax:732-738-1377
Practice Address - Street 1:931 AMBOY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2818
Practice Address - Country:US
Practice Address - Phone:732-738-1366
Practice Address - Fax:732-738-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-09
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPTQA00740800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ118169Medicare PIN