Provider Demographics
NPI:1922160639
Name:MACBETH, JAMES EDWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:MACBETH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5611
Mailing Address - Country:US
Mailing Address - Phone:908-756-8898
Mailing Address - Fax:908-756-8899
Practice Address - Street 1:23 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5611
Practice Address - Country:US
Practice Address - Phone:908-756-8898
Practice Address - Fax:908-756-8899
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00572900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ650022727OtherRAILROAD MEDICARE
NJ8379444OtherCIGNA
NJ552313OtherAETNA
NJ897317000OtherAMERIHEALTH
NJ31001OtherCIGNAORTHONET
NJTS152OtherOXFORD
NJ6602823OtherGHI
NJTS152OtherOXFORD
NJ897317000OtherAMERIHEALTH