Provider Demographics
NPI:1780901330
Name:BRUNSWICK PHYSICAL THERAPY AND REHABILITATION LLC
Entity type:Organization
Organization Name:BRUNSWICK PHYSICAL THERAPY AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDILBERTO
Authorized Official - Middle Name:ORCULLO
Authorized Official - Last Name:ESTOMO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:201-951-7534
Mailing Address - Street 1:725 RIVER RD
Mailing Address - Street 2:SUITE 32-253
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1171
Mailing Address - Country:US
Mailing Address - Phone:201-951-7534
Mailing Address - Fax:201-758-5095
Practice Address - Street 1:725 RIVER RD
Practice Address - Street 2:SUITE 32-253
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1171
Practice Address - Country:US
Practice Address - Phone:201-951-7534
Practice Address - Fax:201-758-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA005204002251H1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman FactorsGroup - Multi-Specialty