Provider Demographics
NPI:1548208580
Name:NEW BRUNSWICK PHYSICAL THERAPY,PA
Entity Type:Organization
Organization Name:NEW BRUNSWICK PHYSICAL THERAPY,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEFESOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-828-3100
Mailing Address - Street 1:330 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3469
Mailing Address - Country:US
Mailing Address - Phone:732-828-3100
Mailing Address - Fax:
Practice Address - Street 1:330 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3469
Practice Address - Country:US
Practice Address - Phone:732-828-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00431400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty