Basic Information
Provider Information
NPI: 1821044678
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPECIALE
FirstName: WILLIAM
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 161 MILLBURN AVE
Address2: MCRC PHYSICAL THERAPY
City: MILLBURN
State: NJ
PostalCode: 070411825
CountryCode: US
TelephoneNumber: 9733767100
FaxNumber: 9733767101
Practice Location
Address1: 449 MARKET ST
Address2: MCRC PHYSICAL THERAPY
City: SADDLE BROOK
State: NJ
PostalCode: 076635941
CountryCode: US
TelephoneNumber: 2017125533
FaxNumber: 2017125551
Other Information
ProviderEnumerationDate: 05/25/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X40QA00039000NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


Home