Provider Demographics
NPI:1104554633
Name:FAMILY PM LLC
Entity type:Organization
Organization Name:FAMILY PM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPOSHNIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-546-1383
Mailing Address - Street 1:300 CRAIG RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8742
Mailing Address - Country:US
Mailing Address - Phone:732-546-1383
Mailing Address - Fax:
Practice Address - Street 1:300 CRAIG RD STE 204
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8742
Practice Address - Country:US
Practice Address - Phone:732-546-1383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)