Form Functional Health Llc

LBN: Form Functional Health Llc
Form Functional Health Llc is an health care organization with primary practice located at 15 Godwin Ave Ste 1 , Ridgewood NJ 07450-3739. The organization recently has only one registered license in Ambulatory Health Care Facilities / Physical Therapy, which is considered as the primary health care specialty. Form Functional Health Llc can be contacted via phone (973) 841-4800, or through Lagonigro, Raffaele via phone (973) 464-6356.

Contact Information

Primary practice address
15 Godwin Ave Ste 1 Ridgewood NJ 07450-3739
Phone: (973) 841-4800
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Lagonigro, Raffaele PT, DPT
Phone: (973) 464-6356

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Physical Therapy 261QP2000X

Profile Details

NPI number 1043999196
LBN Legal business name Form Functional Health Llc
DBA Doing business as
Authorized official Lagonigro, Raffaele PT, DPT
Entity Organization
Organization subpart 1 No
Enumeration date Jul 17th, 2023
Last updated Apr 12th, 2024 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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