1023456647 NPI number — FREEDOM PHYSICAL MEDICINE AND REHABILITATION, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023456647 NPI number — FREEDOM PHYSICAL MEDICINE AND REHABILITATION, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREEDOM PHYSICAL MEDICINE AND REHABILITATION, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023456647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 BROAD AVE
Provider Second Line Business Mailing Address:
SUITE 309
Provider Business Mailing Address City Name:
PALISADES PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07650-1886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-313-1125
Provider Business Mailing Address Fax Number:
201-313-1135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 SYLVAN AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ENGLEWOOD CLIFFS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07632-2724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-227-8275
Provider Business Practice Location Address Fax Number:
201-227-6113
Provider Enumeration Date:
06/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CHANG
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-384-4913

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA08436000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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