# PANDA PHYSICAL MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043711203
- **Authorized official:** CHARLES A FERRANTE DC (CLINIC MANAGER)
- **Authorized official phone:** (732) 455-1375

## Contact information

- **Practice address:** 142 HIGHWAY 35 STE 107, EATONTOWN, NJ 07724-1864
- **Practice address phone:** (732) 898-3040
- **Practice address fax:** (732) 531-1200
- **Mailing address:** 904 DEAL RD APT 12, OCEAN, NJ 07712-3443
- **Mailing address phone:** (732) 455-1375
- **Mailing address fax:** (732) 230-7680

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 174400000X | Specialist | — | NULL | — |
| 174400000X | Specialist | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2018
- **Last updated:** 05/27/2022