Provider Demographics
NPI:1871510958
Name:BERGENFIELD PHYSICAL THERAPY AND REHABILITATION, INC
Entity Type:Organization
Organization Name:BERGENFIELD PHYSICAL THERAPY AND REHABILITATION, INC
Other - Org Name:BERGENFIELD PHYSICAL THERAPY AND PAIN MANAGEMENT, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE ANMOSEL
Authorized Official - Middle Name:PASTRANO
Authorized Official - Last Name:LOZADA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-384-0200
Mailing Address - Street 1:108 S WASHINGTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2341
Mailing Address - Country:US
Mailing Address - Phone:201-384-0200
Mailing Address - Fax:201-384-0030
Practice Address - Street 1:108 S WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2341
Practice Address - Country:US
Practice Address - Phone:201-384-0200
Practice Address - Fax:201-384-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00718000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076474SGKOtherMEDICARE PIN
NJ606458100OtherACS DEPT OF LABOR
NJJ32610OtherHEALTHNET
NJ064850SGKOtherMEDICARE PIN
NJJ32610OtherHEALTHNET
NJ606458100OtherACS DEPT OF LABOR
NJ064850SGKOtherMEDICARE PIN