1043763931 NPI number — C.A.R.Y.N. PHYSICAL THERAPY LLC

Table of content: (NPI 1043763931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043763931 NPI number — C.A.R.Y.N. PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C.A.R.Y.N. PHYSICAL THERAPY LLC
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:
6
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:
1043763931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 GARDEN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORADELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07649-2217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-537-4888
Provider Business Mailing Address Fax Number:
201-734-6132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 N. SUMMIT ST.
Provider Second Line Business Practice Location Address:
1ST FLOOR, SUITE D
Provider Business Practice Location Address City Name:
TENAFLY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07670-2027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-537-4888
Provider Business Practice Location Address Fax Number:
201-734-6132
Provider Enumeration Date:
07/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SEVILLE
Authorized Official First Name:
PURISSA
Authorized Official Middle Name:
ALCUINO
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
210-537-4888

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: 40QA008403 00 , 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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