Basic Information
| Provider Information | |||||||||
| NPI: | 1851452387 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JERSEY CENTRAL PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2147 ROUTE 27 | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327779733 | ||||||||
| FaxNumber: | 7327779730 | ||||||||
| Practice Location | |||||||||
| Address1: | 2147 ROUTE 27 | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327779733 | ||||||||
| FaxNumber: | 7327779730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | IVASHENKO | ||||||||
| AuthorizedOfficialFirstName: | CAROLINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7327779733 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.