Provider Demographics
NPI:1205168457
Name:GOLDMAN PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:GOLDMAN PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:V
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:646-321-2639
Mailing Address - Street 1:20 NORDHOFF PL FL 2
Mailing Address - Street 2:THE GYM
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4811
Mailing Address - Country:US
Mailing Address - Phone:201-567-9399
Mailing Address - Fax:201-567-9394
Practice Address - Street 1:20 NORDHOFF PL FL 2
Practice Address - Street 2:THE GYM
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4811
Practice Address - Country:US
Practice Address - Phone:201-567-9399
Practice Address - Fax:201-567-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01155800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJZL5614OtherHEALTHNET
NJG4194239OtherOXFORD -OUT OF NETWRK
NJ40QA01155800OtherNJ LICENSE
NJP4064332OtherOXFORD HEALTH - OON
NJ40QA01155800OtherNJ LICENSE