Provider Demographics
NPI:1316280837
Name:PHYSICAL MEDICINE OF NEW JERSEY LLC
Entity type:Organization
Organization Name:PHYSICAL MEDICINE OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HETZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-523-5252
Mailing Address - Street 1:234 MCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-1021
Mailing Address - Country:US
Mailing Address - Phone:973-523-5252
Mailing Address - Fax:973-523-5246
Practice Address - Street 1:234 MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504-1021
Practice Address - Country:US
Practice Address - Phone:973-523-5252
Practice Address - Fax:973-523-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07379000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty