Provider Demographics
NPI:1568855948
Name:VANGUARD PHYSICAL THERAPY
Entity Type:Organization
Organization Name:VANGUARD PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:IMPLICITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-845-6030
Mailing Address - Street 1:113 W ESSEX ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1020
Mailing Address - Country:US
Mailing Address - Phone:201-845-6030
Mailing Address - Fax:201-845-6040
Practice Address - Street 1:113 W ESSEX ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1020
Practice Address - Country:US
Practice Address - Phone:201-845-6030
Practice Address - Fax:201-845-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy