Provider Demographics
NPI:1679936272
Name:FOUR 3 PERFORMANCE LABORATORY CORP
Entity type:Organization
Organization Name:FOUR 3 PERFORMANCE LABORATORY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOTTINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:973-794-6040
Mailing Address - Street 1:315 WOOTTON ST
Mailing Address - Street 2:UNITS I & J
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 WOOTTON ST
Practice Address - Street 2:UNITS I & J
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005
Practice Address - Country:US
Practice Address - Phone:201-739-2039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy