Provider Demographics
NPI:1609002591
Name:ADVANCED PHYSICAL THERAPY & SPINAL CARE, LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY & SPINAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:POGORELEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-712-0009
Mailing Address - Street 1:383 MARKET ST
Mailing Address - Street 2:SUITE B2
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5300
Mailing Address - Country:US
Mailing Address - Phone:201-712-0009
Mailing Address - Fax:201-712-0040
Practice Address - Street 1:383 MARKET ST
Practice Address - Street 2:SUITE B2
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5300
Practice Address - Country:US
Practice Address - Phone:201-712-0009
Practice Address - Fax:201-712-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00559000111N00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty