Provider Demographics
NPI:1568439891
Name:HACKENSACK PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:HACKENSACK PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:FERDINAND
Authorized Official - Middle Name:C
Authorized Official - Last Name:QUIJANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-488-0442
Mailing Address - Street 1:343A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5832
Mailing Address - Country:US
Mailing Address - Phone:201-488-0442
Mailing Address - Fax:201-488-7714
Practice Address - Street 1:343A MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5832
Practice Address - Country:US
Practice Address - Phone:201-488-0442
Practice Address - Fax:201-488-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075673Medicare PIN