Provider Demographics
NPI:1215941976
Name:PROSTHETIC AMBULATION CENTER OF EXCELLENCE
Entity type:Organization
Organization Name:PROSTHETIC AMBULATION CENTER OF EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VALENTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:201-943-3900
Mailing Address - Street 1:522 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1636
Mailing Address - Country:US
Mailing Address - Phone:201-943-3900
Mailing Address - Fax:201-943-9055
Practice Address - Street 1:522 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1636
Practice Address - Country:US
Practice Address - Phone:201-943-3900
Practice Address - Fax:201-943-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092462Medicare ID - Type UnspecifiedOUT PATIENT PT