Provider Demographics
NPI:1851548762
Name:CLIFTON SPORTS MEDICINE & PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CLIFTON SPORTS MEDICINE & PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PONZINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-595-6444
Mailing Address - Street 1:1233 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2241
Mailing Address - Country:US
Mailing Address - Phone:973-595-6444
Mailing Address - Fax:
Practice Address - Street 1:1233 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2241
Practice Address - Country:US
Practice Address - Phone:973-595-6444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00619200111N00000X
NJ38MC00630100111N00000X
NJ25MB06381000204C00000X
NJ40QA01282900261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty