Provider Demographics
NPI:1235545260
Name:SPRING VALLEY ORTHOPEDIC AND REHABILITATION LLC
Entity Type:Organization
Organization Name:SPRING VALLEY ORTHOPEDIC AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-489-9555
Mailing Address - Street 1:6 SPRING VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3801
Mailing Address - Country:US
Mailing Address - Phone:201-489-9555
Mailing Address - Fax:201-489-9569
Practice Address - Street 1:6 SPRING VALLEY AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3801
Practice Address - Country:US
Practice Address - Phone:201-489-9555
Practice Address - Fax:201-489-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00541200111N00000X
NJ25MA07819000207X00000X
NJ25MA06309600207X00000X
NJ40QA01525400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty