Provider Demographics
NPI:1619514841
Name:GANZ, MITCHELL D (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:D
Last Name:GANZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TERENCE DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3438
Mailing Address - Country:US
Mailing Address - Phone:908-907-1818
Mailing Address - Fax:
Practice Address - Street 1:100 MERIDIAN PL
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-4003
Practice Address - Country:US
Practice Address - Phone:908-907-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296802261QP2000X
NJ40QA01986600261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy