Provider Demographics
NPI:1518996503
Name:ACTIVE PHYSICAL THERAPY INST., PA
Entity Type:Organization
Organization Name:ACTIVE PHYSICAL THERAPY INST., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PASKO
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAZIVODA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-794-3223
Mailing Address - Street 1:67 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1836
Mailing Address - Country:US
Mailing Address - Phone:201-794-3223
Mailing Address - Fax:201-794-8411
Practice Address - Street 1:67 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407
Practice Address - Country:US
Practice Address - Phone:201-794-3223
Practice Address - Fax:201-794-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy