Provider Demographics
NPI:1679619258
Name:EGG HARBOR TOWNSHIP PHYSICAL THERAPY & PAIN RELIEF LLC
Entity type:Organization
Organization Name:EGG HARBOR TOWNSHIP PHYSICAL THERAPY & PAIN RELIEF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALBANESE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-615-1585
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-0359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3007 OCEAN HEIGHTS AVE
Practice Address - Street 2:SUITE 101 &102
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-7707
Practice Address - Country:US
Practice Address - Phone:609-601-9555
Practice Address - Fax:609-601-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110043Medicare PIN