Form Functional Health LLC
Clinic/Center, Physical Therapy in Ridgewood, New Jersey
1043999196- Practice location
- 15 Godwin Ave Ste 1, Ridgewood, NJ 07450-3739
- Phone
- 973-841-4800
- Fax
- —
- Last updated
- April 12, 2024
Form Functional Health LLC is a healthcare organization based in Ridgewood, NJ. Form Functional Health LLC practices in Ridgewood, NJ. The NPI Number for Form Functional Health LLC is 1043999196. The current practice location address for Form Functional Health LLC is 15 Godwin Ave Ste 1, Ridgewood, NJ 07450-3739 and can be reached out via phone at 973-841-4800.
Provider Profile Details
- NPI Number
- 1043999196
- Provider Name
- Form Functional Health LLC
- Provider Entity Type
- Organization
- Address
- 15 Godwin Ave Ste 1, Ridgewood, NJ 07450-3739
- Phone Number
- 973-841-4800
- Primary Taxonomy
- Clinic/Center, Physical Therapy · 261QP2000X
- Organization Subpart
- No
- Authorized Official
- Raffaele Lagonigro, PT, DPT · Owner · 973-464-6356
- Provider Enumeration Date
- July 17, 2023
- Last Update Date
- April 12, 2024
- Certification Date
- April 12, 2024
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 15 Godwin Ave Ste 1
Ridgewood, NJ 07450-3739 - City
- Ridgewood
- State
- New Jersey
- Zip
- 07450-3739
- Phone Number
- 973-841-4800
Provider Business Mailing Address Details
- Address
- 15 Godwin Ave Ste 1
Ridgewood, NJ 07450-3739 - City
- Ridgewood
- State
- NJ
- Zip
- 07450-3739
- Phone Number
- 973-841-4800
License Information
- Taxonomy
- Clinic/Center, Physical Therapy · 261QP2000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Form Functional Health LLC?
The NPI number of Form Functional Health LLC is 1043999196. It was assigned on July 17, 2023 and is currently active in the NPPES registry.
What is the specialty of Form Functional Health LLC?
Form Functional Health LLC is registered under the primary taxonomy Clinic/Center, Physical Therapy (code 261QP2000X).
Where does Form Functional Health LLC practice?
The practice location is 15 Godwin Ave Ste 1, Ridgewood, NJ 07450-3739. The office can be reached at 973-841-4800 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1043999196 directly on the NPPES registry website.