Provider Demographics
NPI:1740369347
Name:MADISON PT OF NEW JERSEY, PC
Entity type:Organization
Organization Name:MADISON PT OF NEW JERSEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONOMO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:201-594-9312
Mailing Address - Street 1:219 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-2517
Mailing Address - Country:US
Mailing Address - Phone:201-594-9312
Mailing Address - Fax:201-907-0404
Practice Address - Street 1:400 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2732
Practice Address - Country:US
Practice Address - Phone:201-594-9312
Practice Address - Fax:201-907-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty