Provider Demographics
NPI:1194895334
Name:OVERMAN, ANDREW PENNELL
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PENNELL
Last Name:OVERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:THREE BRIDGES
Mailing Address - State:NJ
Mailing Address - Zip Code:08887-0310
Mailing Address - Country:US
Mailing Address - Phone:908-806-2645
Mailing Address - Fax:908-806-5228
Practice Address - Street 1:8 BARTLES CORNER ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5712
Practice Address - Country:US
Practice Address - Phone:908-806-2000
Practice Address - Fax:908-806-2003
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00981700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
054313N52Medicare ID - Type Unspecified