1265948681 NPI number — PATRICK RICHAD KILDUFF PT, DPT, LSVT

Table of content: PATRICK RICHAD KILDUFF PT, DPT, LSVT (NPI 1265948681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265948681 NPI number — PATRICK RICHAD KILDUFF PT, DPT, LSVT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILDUFF
Provider First Name:
PATRICK
Provider Middle Name:
RICHAD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, LSVT
Provider Gender Code:
M

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:
1265948681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
755 MEMORIAL PKWY STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILLIPSBURG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08865-2774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-847-9780
Provider Business Mailing Address Fax Number:
908-847-9786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 MEMORIAL PKWY STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08865-2774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-847-9780
Provider Business Practice Location Address Fax Number:
908-847-9786
Provider Enumeration Date:
12/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA01765900 , 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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