Provider Demographics
NPI:1679599294
Name:ALL GARDEN STATE PHYSICAL THERAPY & SPORTS MEDICINE CENTER, INC.
Entity type:Organization
Organization Name:ALL GARDEN STATE PHYSICAL THERAPY & SPORTS MEDICINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHAPARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-345-1312
Mailing Address - Street 1:750 BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1332
Mailing Address - Country:US
Mailing Address - Phone:973-345-1312
Mailing Address - Fax:973-742-0669
Practice Address - Street 1:750 BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1332
Practice Address - Country:US
Practice Address - Phone:973-345-1312
Practice Address - Fax:973-742-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA04745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0026083OtherAETNA
1K7011OtherHEALTH NET
1K7011OtherHEALTH NET