Provider Demographics
NPI:1841245677
Name:MCRC PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MCRC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-376-7100
Mailing Address - Street 1:161 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1825
Mailing Address - Country:US
Mailing Address - Phone:732-739-5545
Mailing Address - Fax:732-739-5547
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:BUILDING 2, SUITE 27
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-739-5545
Practice Address - Fax:732-739-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
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
087104Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER