Provider Demographics
NPI:1649201575
Name:GARDEN STATE FAMILY CARE, P.C.
Entity Type:Organization
Organization Name:GARDEN STATE FAMILY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELKADZE
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:908-620-0808
Mailing Address - Street 1:39 JUNIPER PLACE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1832
Mailing Address - Country:US
Mailing Address - Phone:908-620-0808
Mailing Address - Fax:
Practice Address - Street 1:221 CHESTNUT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-1297
Practice Address - Country:US
Practice Address - Phone:908-620-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099021Medicare ID - Type Unspecified