Provider Demographics
NPI:1336753243
Name:PERFORMANCE MEDICAL GROUP OF BRANCHBURG LLC
Entity Type:Organization
Organization Name:PERFORMANCE MEDICAL GROUP OF BRANCHBURG LLC
Other - Org Name:PERFORMANCE REHABILITATION AND REGENERATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOM
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-756-2424
Mailing Address - Street 1:10 JOHNSTON DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-4905
Mailing Address - Country:US
Mailing Address - Phone:908-756-2424
Mailing Address - Fax:
Practice Address - Street 1:454 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5111
Practice Address - Country:US
Practice Address - Phone:908-756-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERFORMANCE MEDICAL GROUP OF BRANCHBURG LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-08
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty