Organization Name: | GARDEN STATE PHYSICAL THERAPY PC |
NPI Number: | 1568677516 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALEXANDER GARDUQUE (OWNER DIRECTOR OF REHAB SERVICES) |
Mailing Address: | 44 Ridge Rd North Arlington |
State: | NJ US |
Postal Code: | 070316350 |
Phone Number: | 2019986300 |
Fax Number: | 2019986344 |
NPI Enumeration Date: | 05/13/2007 |
NPI Last Update Date: | 10/10/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | PT40QA00804200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |