Provider Demographics
NPI:1134665722
Name:KINDERKAMACK PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:KINDERKAMACK PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINSUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-983-9905
Mailing Address - Street 1:800 KINDERKAMACK RD STE 207N
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1546
Mailing Address - Country:US
Mailing Address - Phone:201-983-9905
Mailing Address - Fax:
Practice Address - Street 1:800 KINDERKAMACK RD STE 207N
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1546
Practice Address - Country:US
Practice Address - Phone:201-983-9905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01699400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty