1922665082 NPI number — BRANCH PHYSICAL THERAPY & WELLNESS PC

Table of content: RANJANA SRINATH LORD RD (NPI 1417473687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922665082 NPI number — BRANCH PHYSICAL THERAPY & WELLNESS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRANCH PHYSICAL THERAPY & WELLNESS PC
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:
1922665082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 JACKSON ST APT 839
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOBOKEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07030-6973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-565-6342
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 WASHINGTON ST STE 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TENAFLY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07670-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-565-6342
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTODOULOU
Authorized Official First Name:
MARIOS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-565-6342

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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