Provider Demographics
NPI:1689904807
Name:PARADIGM PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:PARADIGM PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:201-780-9691
Mailing Address - Street 1:5 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1435
Mailing Address - Country:US
Mailing Address - Phone:201-780-9691
Mailing Address - Fax:
Practice Address - Street 1:1556 3RD AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3100
Practice Address - Country:US
Practice Address - Phone:201-780-9691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024310261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy