Provider Demographics
NPI:1942550041
Name:MILLENNIUM PHYSICAL THERAPY III
Entity Type:Organization
Organization Name:MILLENNIUM PHYSICAL THERAPY III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-529-8322
Mailing Address - Street 1:300 ROUTE 17
Mailing Address - Street 2:SUITE G
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2141
Mailing Address - Country:US
Mailing Address - Phone:201-529-8322
Mailing Address - Fax:201-529-8377
Practice Address - Street 1:300 ROUTE 17
Practice Address - Street 2:SUITE G
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-2141
Practice Address - Country:US
Practice Address - Phone:201-529-8322
Practice Address - Fax:201-529-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00333400261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy