Provider Demographics
NPI:1235513987
Name:KIPNIS PHYSICAL THERAPY AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:KIPNIS PHYSICAL THERAPY AND SPORTS MEDICINE
Other - Org Name:KIPNIS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STRANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-319-0010
Mailing Address - Street 1:151 SUSSEX ST APT 3
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4415
Mailing Address - Country:US
Mailing Address - Phone:201-572-9306
Mailing Address - Fax:
Practice Address - Street 1:150 FLANAGAN WAY
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3445
Practice Address - Country:US
Practice Address - Phone:201-319-0010
Practice Address - Fax:201-319-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01389100261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy