Provider Demographics
NPI:1982048567
Name:OPTIMUM ORTHOPEDICS PHYSICAL THERAPY RIVER EDGE, LLC
Entity Type:Organization
Organization Name:OPTIMUM ORTHOPEDICS PHYSICAL THERAPY RIVER EDGE, LLC
Other - Org Name:OPTIMUM ORTHOPEDICS PHYSICAL THERPAY & SPORTS REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RASPANTI
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:973-746-2424
Mailing Address - Street 1:530 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-2140
Mailing Address - Country:US
Mailing Address - Phone:973-746-2424
Mailing Address - Fax:
Practice Address - Street 1:530 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2140
Practice Address - Country:US
Practice Address - Phone:973-746-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty