Provider Demographics
NPI:1568657625
Name:MILLENNIUM PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MILLENNIUM PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-225-9222
Mailing Address - Street 1:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07653-0691
Mailing Address - Country:US
Mailing Address - Phone:201-225-9222
Mailing Address - Fax:201-225-9223
Practice Address - Street 1:600 WINTERS AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3904
Practice Address - Country:US
Practice Address - Phone:201-225-9222
Practice Address - Fax:201-225-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ034143Medicare PIN