Provider Demographics
NPI:1730461963
Name:PERFORMANCE ENHANCEMENT CONCEPTS, LLC
Entity Type:Organization
Organization Name:PERFORMANCE ENHANCEMENT CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-750-4700
Mailing Address - Street 1:55 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-1335
Mailing Address - Country:US
Mailing Address - Phone:201-750-4700
Mailing Address - Fax:201-750-4701
Practice Address - Street 1:55 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07648-1335
Practice Address - Country:US
Practice Address - Phone:201-750-4700
Practice Address - Fax:201-750-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00376400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ064544Medicare PIN