Provider Demographics
NPI:1649334814
Name:NEWARK PHYSICAL THERAPY
Entity type:Organization
Organization Name:NEWARK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:FESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-485-1011
Mailing Address - Street 1:1 BLOOMFIELD AVE
Mailing Address - Street 2:STE. 201
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4807
Mailing Address - Country:US
Mailing Address - Phone:973-485-1011
Mailing Address - Fax:
Practice Address - Street 1:1 BLOOMFIELD AVE
Practice Address - Street 2:STE. 201
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4807
Practice Address - Country:US
Practice Address - Phone:973-485-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities