Provider Demographics
NPI:1215392691
Name:TRINITAS CHILDREN'S THERAPY SERVICES
Entity Type:Organization
Organization Name:TRINITAS CHILDREN'S THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, MANAGER
Authorized Official - Phone:973-218-6394
Mailing Address - Street 1:899 MOUNTAIN AVENUE, SUITE 1A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081
Mailing Address - Country:US
Mailing Address - Phone:973-218-6394
Mailing Address - Fax:973-218-6351
Practice Address - Street 1:899 MOUNTAIN AVENUE
Practice Address - Street 2:SUITE 1A
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081
Practice Address - Country:US
Practice Address - Phone:973-218-6394
Practice Address - Fax:973-218-6351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA0097952251P0200X
NJ46TR00292210225XP0200X
NJ41YS00609200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty