Organization
GARDEN STATE PHYSICAL THERAPY AND WELLNESS CENTER LLC
Active
Organization
GARDEN STATE PHYSICAL THERAPY AND WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. OLFEA DIGAMON MANGLE P.T. (PRESIDENT)
(908) 354-1511
Entity
Organization
Contact information
Practice address
700 N BROAD ST STE 102, ELIZABETH, NJ 07208-2310
(908) 354-1511
(908) 659-9229
Mailing address
700 N BROAD ST STE 102, ELIZABETH, NJ 07208-2310
(908) 354-1511
(908) 659-9229
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
40QA00504100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000-225-0032-04
UNITED HEALTHCARE
NJ
01
—
001590204
AMERIHEALTH
NJ
01
—
3K4126
HEALTHNET
NJ
01
—
44902
ORTHONET
NJ
01
—
687933
ACN GROUP
NJ
01
—
P3440262
OXFORD
NJ
01
—
Q23Q61
CIGNA
NJ
Enumeration date
02/07/2007
Last updated
06/21/2018
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