Provider Demographics
NPI:1063833846
Name:PHYSICAL INFINITY MEDICAL PC
Entity Type:Organization
Organization Name:PHYSICAL INFINITY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAITSES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-333-9300
Mailing Address - Street 1:263 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1180
Mailing Address - Country:US
Mailing Address - Phone:201-333-9300
Mailing Address - Fax:
Practice Address - Street 1:263 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1180
Practice Address - Country:US
Practice Address - Phone:201-333-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty