Provider Demographics
NPI:1407108434
Name:ACHIEVE SPORTMEDICINE REHAB
Entity Type:Organization
Organization Name:ACHIEVE SPORTMEDICINE REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:KRINGLE
Authorized Official - Last Name:MCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-891-0411
Mailing Address - Street 1:668 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1430
Mailing Address - Country:US
Mailing Address - Phone:201-891-0411
Mailing Address - Fax:
Practice Address - Street 1:668 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1430
Practice Address - Country:US
Practice Address - Phone:201-891-0411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00327500251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare