Basic Information
| Provider Information | |||||||||
| NPI: | 1730631433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERTZOG | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 79 MANITO AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074363707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092357034 | ||||||||
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| Practice Location | |||||||||
| Address1: | 608 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | HOBOKEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070305170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014840134 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2016 | ||||||||
| LastUpdateDate: | 10/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01700100 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 62006 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.