Provider Demographics
NPI:1265484331
Name:KIPNIS ORTHOPAEDIC REHAB OF SECAUCUS LLC
Entity Type:Organization
Organization Name:KIPNIS ORTHOPAEDIC REHAB OF SECAUCUS LLC
Other - Org Name:KIPNIS REHAB OF SECAUCUS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ILENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPNIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-319-0010
Mailing Address - Street 1:150 FLANAGAN WAY
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3433
Mailing Address - Country:US
Mailing Address - Phone:201-319-0010
Mailing Address - Fax:201-319-0349
Practice Address - Street 1:150 FLANAGAN WAY
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3433
Practice Address - Country:US
Practice Address - Phone:201-319-0010
Practice Address - Fax:201-319-0349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00411700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ082670Medicare PIN