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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