Provider Demographics
NPI:1730138512
Name:JERSEY PHYSICAL THERAPY OF MILLTOWN/EAST BRUNSWICK
Entity Type:Organization
Organization Name:JERSEY PHYSICAL THERAPY OF MILLTOWN/EAST BRUNSWICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:732-418-7033
Mailing Address - Street 1:3228 STATE ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1524
Mailing Address - Country:US
Mailing Address - Phone:732-297-0032
Mailing Address - Fax:732-418-7011
Practice Address - Street 1:180 TICES LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1337
Practice Address - Country:US
Practice Address - Phone:732-418-7033
Practice Address - Fax:732-418-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2014-03-03
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
NJ7074461OtherAETNA PROVIDER NUMBER
NJ7074461OtherAETNA PROVIDER NUMBER
NJ=========OtherHBCBSOF NJ