Basic Information
Provider Information
NPI: 1134722341
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALBANESE
FirstName: CHRISTOPHER
MiddleName: G
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 224 STRAWBRIDGE DR STE 100
Address2:  
City: MOORESTOWN
State: NJ
PostalCode: 080574602
CountryCode: US
TelephoneNumber: 8566774000
FaxNumber: 8562343014
Practice Location
Address1: 2123 HIGHWAY 35
Address2:  
City: SEA GIRT
State: NJ
PostalCode: 087501003
CountryCode: US
TelephoneNumber: 7324492001
FaxNumber: 7324492238
Other Information
ProviderEnumerationDate: 11/19/2020
LastUpdateDate: 06/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X40QA01918500NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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