Provider Demographics
NPI:1184951501
Name:FUNCTIONAL PERFORMANCE INSTITUTE PC
Entity type:Organization
Organization Name:FUNCTIONAL PERFORMANCE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DAMELIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-432-4334
Mailing Address - Street 1:313 SOUTH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1364
Mailing Address - Country:US
Mailing Address - Phone:908-288-7049
Mailing Address - Fax:908-288-7225
Practice Address - Street 1:2 CHANGEBRIDGE RD
Practice Address - Street 2:UNIT F
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-8947
Practice Address - Country:US
Practice Address - Phone:908-432-4334
Practice Address - Fax:908-469-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ170422Medicare PIN