Provider Demographics
NPI:1821677956
Name:PHYSICAL THERAPY DOCTOR NJ, PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY DOCTOR NJ, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOOKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-847-9922
Mailing Address - Street 1:719 N BEERS ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1523
Mailing Address - Country:US
Mailing Address - Phone:732-847-9922
Mailing Address - Fax:
Practice Address - Street 1:719 N BEERS ST STE 2B
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1523
Practice Address - Country:US
Practice Address - Phone:732-847-9922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy