Provider Demographics
NPI:1083871461
Name:HAYUT, AVISHAY (PT)
Entity Type:Individual
Prefix:
First Name:AVISHAY
Middle Name:
Last Name:HAYUT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LAWRENCE PKWY
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2705
Mailing Address - Country:US
Mailing Address - Phone:201-871-2406
Mailing Address - Fax:201-871-2420
Practice Address - Street 1:29 LAWRENCE PKWY
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2705
Practice Address - Country:US
Practice Address - Phone:201-871-2406
Practice Address - Fax:201-871-2420
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00416100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist