Provider Demographics
NPI:1952515058
Name:PEN PHYSICAL THERAPY & REHAB SERVICES, P.C.
Entity type:Organization
Organization Name:PEN PHYSICAL THERAPY & REHAB SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COMFORT
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBONNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-406-9363
Mailing Address - Street 1:1450 PARKSIDE AVE
Mailing Address - Street 2:SUITE 26
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2946
Mailing Address - Country:US
Mailing Address - Phone:609-406-9363
Mailing Address - Fax:
Practice Address - Street 1:1450 PARKSIDE AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-2946
Practice Address - Country:US
Practice Address - Phone:609-406-9363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096473Medicare UPIN