Provider Demographics
NPI:1336247220
Name:EAST COAST PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:EAST COAST PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONCA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-366-2600
Mailing Address - Street 1:3155 STATE ROUTE 10
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3492
Mailing Address - Country:US
Mailing Address - Phone:973-366-2600
Mailing Address - Fax:973-366-7874
Practice Address - Street 1:3155 STATE ROUTE 10
Practice Address - Street 2:SUITE 112
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-3492
Practice Address - Country:US
Practice Address - Phone:973-366-2600
Practice Address - Fax:973-366-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00422700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJX-27912Medicare UPIN
NJEA-001554Medicare ID - Type Unspecified