Provider Demographics
NPI:1932316023
Name:OMNITHERAPY CENTER, LLC
Entity Type:Organization
Organization Name:OMNITHERAPY CENTER, LLC
Other - Org Name:ANA POZZOLI, PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:POZZOLI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-429-0890
Mailing Address - Street 1:1018 BROAD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2884
Mailing Address - Country:US
Mailing Address - Phone:973-429-0890
Mailing Address - Fax:973-748-8661
Practice Address - Street 1:1018 BROAD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2884
Practice Address - Country:US
Practice Address - Phone:973-429-0890
Practice Address - Fax:973-748-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1409747-04OtherUNITEDHEALTHCARE
NJ2694024OtherAETNA
NJ050382Medicare UPIN