NPIMap

Organization Active NPI

Four 3 Performance Laboratory Corp

  • Physical Therapy Clinic/Center
  • Boonton, NJ
National Provider Identifier
1679936272
Registry record updated Dec 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
FOUR 3 PERFORMANCE LABORATORY CORP
Practice address
315 Wootton St
Units I & J
Boonton, NJ 07005
Phone
(201) 739-2039
NPI assigned
Mar 31, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William A. Bottino Jr., PTNPI 1073720165
Title
Owner
Phone
(973) 794-6040

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

315 Wootton St
Units I & J
Boonton, NJ 07005

Mailing address

315 Wootton St
Units I & J
Boonton, NJ 07005-1939

Other practice location 1

275 Comly Rd Unit 2
Lincoln Park, NJ 07035-1720
Phone (973) 706-7725

Other practice location 2

574 Newark Pompton Tpke
Pompton Plains, NJ 07444-1746
Phone (862) 330-3044

Other practice location 3

579 Goffle Rd
Wyckoff, NJ 07481-2946
Phone (201) 857-5910

Other practice location 4

6 Kingsbridge Rd Ste 4
Fairfield, NJ 07004-2100
Phone (973) 794-6040

Other practice location 5

47 Wanaque Ave Unit 13
Pompton Lakes, NJ 07442-2023
Phone (862) 200-5144

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180807002717 NJ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3779831714 Receives reassigned benefits from 12 practitioners
Practice locations: Boonton, NJ; Lincoln Park, NJ; Pompton Lakes, NJ; Wyckoff, NJ

National Provider Directory

National Provider Directory

Locations

315 Wootton St
Ste I
Boonton, NJ 07005
Phone (973) 794-6040

6 Kingsbridge Rd
Ste 4
Fairfield, NJ 07004
Phone (973) 794-6040

275 Comly Rd
Ste 2
Lincoln Park, NJ 07035
Phone (973) 706-7725

47 Wanaque Ave
Unit 13
Pompton Lakes, NJ 07442
Phone (862) 200-5144

47 Wanaque Ave
Ste 13
Pompton Lakes, NJ 07442
Phone (862) 200-5144

574 Newark Pompton Tpke
Pompton Plains, NJ 07444
Phone (862) 330-3044

574 Newark Pompton Tpke
Ste 3
Pompton Plains, NJ 07444
Phone (862) 330-3044

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639180800000",
    "number": "1679936272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 WOOTTON ST",
            "address_2": "UNITS I & J",
            "city": "BOONTON",
            "state": "NJ",
            "postal_code": "070051939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 WOOTTON ST",
            "address_2": "UNITS I & J",
            "city": "BOONTON",
            "state": "NJ",
            "postal_code": "07005",
            "telephone_number": "201-739-2039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "275 Comly Rd Unit 2",
            "address_purpose": "LOCATION",
            "city": "Lincoln Park",
            "state": "NJ",
            "postal_code": "070351720",
            "country_code": "US",
            "telephone_number": "973-706-7725",
            "fax_number": "973-706-7726",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "574 Newark Pompton Tpke",
            "address_purpose": "LOCATION",
            "city": "Pompton Plains",
            "state": "NJ",
            "postal_code": "074441746",
            "country_code": "US",
            "telephone_number": "862-330-3044",
            "fax_number": "862-330-3045",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "579 Goffle Rd",
            "address_purpose": "LOCATION",
            "city": "Wyckoff",
            "state": "NJ",
            "postal_code": "074812946",
            "country_code": "US",
            "telephone_number": "201-857-5910",
            "fax_number": "201-857-5911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6 Kingsbridge Rd Ste 4",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "NJ",
            "postal_code": "070042100",
            "country_code": "US",
            "telephone_number": "973-794-6040",
            "fax_number": "973-794-6041",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "47 Wanaque Ave Unit 13",
            "address_purpose": "LOCATION",
            "city": "Pompton Lakes",
            "state": "NJ",
            "postal_code": "074422023",
            "country_code": "US",
            "telephone_number": "862-200-5144",
            "fax_number": "862-200-5145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOUR 3 PERFORMANCE LABORATORY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-31",
        "last_updated": "2021-12-11",
        "certification_date": "2021-12-11",
        "status": "A",
        "authorized_official_last_name": "BOTTINO",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-794-6040",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boonton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.