Provider Demographics
NPI:1396881553
Name:ADVANCED ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Entity type:Organization
Organization Name:ADVANCED ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-528-3850
Mailing Address - Street 1:2444 HIGHWAY 34
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1808
Mailing Address - Country:US
Mailing Address - Phone:732-528-3850
Mailing Address - Fax:732-528-3851
Practice Address - Street 1:2444 HIGHWAY 34
Practice Address - Street 2:SUITE 2
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1808
Practice Address - Country:US
Practice Address - Phone:732-528-3850
Practice Address - Fax:732-528-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ023582Medicare ID - Type UnspecifiedPROVIDER NUMBER