Provider Demographics
NPI:1972706455
Name:DAVID M. FENIGER
Entity Type:Organization
Organization Name:DAVID M. FENIGER
Other - Org Name:BROADWAY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FENIGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-437-0313
Mailing Address - Street 1:1039 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3217
Mailing Address - Country:US
Mailing Address - Phone:201-437-0313
Mailing Address - Fax:201-437-3811
Practice Address - Street 1:1039 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3217
Practice Address - Country:US
Practice Address - Phone:201-437-0313
Practice Address - Fax:201-437-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA03000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ235288OtherUNITED HEALTHCARE
NJ0040050OtherORTHONET (CIGNA)
NJ123521OtherAETNA HEALTH PLANS
NJANC840OtherORTHONET (OXFORD)
NJ0040052OtherORTHONET (AETNA)
NJANC840OtherORTHONET (OXFORD)