Provider Demographics
NPI:1063069763
Name:PREMIER CHOICE PHYSICAL THERAPY PA
Entity type:Organization
Organization Name:PREMIER CHOICE PHYSICAL THERAPY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OMBAJIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-281-5790
Mailing Address - Street 1:61 HUDSON ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6935
Mailing Address - Country:US
Mailing Address - Phone:201-581-0778
Mailing Address - Fax:
Practice Address - Street 1:61 HUDSON ST STE 5
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6935
Practice Address - Country:US
Practice Address - Phone:201-581-0778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy