Provider Demographics
NPI:1194195271
Name:JEEVAN THERAPY
Entity Type:Organization
Organization Name:JEEVAN THERAPY
Other - Org Name:ROSEVILLE PHYSICAL THERAPY & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEEVAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-596-9031
Mailing Address - Street 1:500 ORANGE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2944
Mailing Address - Country:US
Mailing Address - Phone:845-596-9031
Mailing Address - Fax:
Practice Address - Street 1:500 ORANGE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2944
Practice Address - Country:US
Practice Address - Phone:845-596-9031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01478100261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3188Medicare PIN