Provider Demographics
NPI:1275060774
Name:WIENERPHYSICALTHERAPYSERVICES
Entity Type:Organization
Organization Name:WIENERPHYSICALTHERAPYSERVICES
Other - Org Name:WIENERPHYSICALTHERAPYSERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:201-937-8336
Mailing Address - Street 1:170 PROSPECT AVE APT 5L
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1858
Mailing Address - Country:US
Mailing Address - Phone:201-880-0952
Mailing Address - Fax:201-880-4893
Practice Address - Street 1:484 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2522
Practice Address - Country:US
Practice Address - Phone:201-880-0952
Practice Address - Fax:201-880-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA03741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty