Organization
FORM FUNCTIONAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAFFAELE LAGONIGRO PT, DPT (OWNER)
(973) 464-6356
Entity
Organization
Contact information
Practice address
15 GODWIN AVE STE 1, RIDGEWOOD, NJ 07450-3739
(973) 841-4800
Mailing address
15 GODWIN AVE STE 1, RIDGEWOOD, NJ 07450-3739
(973) 841-4800
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
07/17/2023
Last updated
04/12/2024
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