1487011672 NPI number — KINETIC PHYSICAL THERAPY OF HACKENSACK, PA

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 1487011672 NPI number — KINETIC PHYSICAL THERAPY OF HACKENSACK, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINETIC PHYSICAL THERAPY OF HACKENSACK, PA
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:
1487011672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 LAKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAMSEY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07446-2089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-327-1990
Provider Business Mailing Address Fax Number:
201-327-1921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
182 KINDERKAMACK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK RIDGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07656-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-573-0066
Provider Business Practice Location Address Fax Number:
201-573-0068
Provider Enumeration Date:
01/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CHAIT
Authorized Official First Name:
EVAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-327-1990

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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