1871916130 NPI number — PRO STAFF DYNAMIC HAND THERAPY, INC.

Table of content: (NPI 1871916130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871916130 NPI number — PRO STAFF DYNAMIC HAND THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO STAFF DYNAMIC HAND THERAPY, INC.
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:
PRO STAFF REHAB & WELLNESS, INC.
Provider Other Organization Name Type Code:
4
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:
1871916130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
265 FRANKLIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NUTLEY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07110-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-680-8390
Provider Business Mailing Address Fax Number:
973-680-8391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 CLAREMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07042-4854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-680-8390
Provider Business Practice Location Address Fax Number:
973-680-8391
Provider Enumeration Date:
01/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KOPIDLOWSKI
Authorized Official First Name:
JACLYN
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-766-3523

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  46TR00508400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0404X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com