Provider Demographics
NPI:1205090909
Name:PHYSICAL MEDICINE CONSULTANTS, LLC
Entity type:Organization
Organization Name:PHYSICAL MEDICINE CONSULTANTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:NICOLA
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-325-0229
Mailing Address - Street 1:81 NORTHFIELD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5342
Mailing Address - Country:US
Mailing Address - Phone:973-325-0229
Mailing Address - Fax:
Practice Address - Street 1:81 NORTHFIELD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5342
Practice Address - Country:US
Practice Address - Phone:973-325-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07753800261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0072770Medicaid
NJ0072770Medicaid
NJ086285Medicare PIN