Provider Demographics
NPI:1699962902
Name:FORSGATE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:FORSGATE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAMATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-860-9913
Mailing Address - Street 1:1 ROSSMOOR DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1566
Mailing Address - Country:US
Mailing Address - Phone:609-860-9913
Mailing Address - Fax:
Practice Address - Street 1:1 ROSSMOOR DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1566
Practice Address - Country:US
Practice Address - Phone:609-860-9913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00817300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084725Medicare PIN