Provider Demographics
NPI:1851452387
Name:JERSEY CENTRAL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:JERSEY CENTRAL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:IVASHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-777-9733
Mailing Address - Street 1:2147 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817
Mailing Address - Country:US
Mailing Address - Phone:732-777-9733
Mailing Address - Fax:732-777-9730
Practice Address - Street 1:2147 ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:732-777-9733
Practice Address - Fax:732-777-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
316603Medicare ID - Type Unspecified