Basic Information
| Provider Information | |||||||||
| NPI: | 1982048567 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OPTIMUM ORTHOPEDICS PHYSICAL THERAPY RIVER EDGE, LLC | ||||||||
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| OtherOrganizationName: | OPTIMUM ORTHOPEDICS PHYSICAL THERPAY & SPORTS REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 KINDERKAMACK RD | ||||||||
| Address2: | |||||||||
| City: | RIVER EDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076612140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737462424 | ||||||||
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| Practice Location | |||||||||
| Address1: | 530 KINDERKAMACK RD | ||||||||
| Address2: | |||||||||
| City: | RIVER EDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076612140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737462424 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2013 | ||||||||
| LastUpdateDate: | 04/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | RASPANTI | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9737462424 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.