Provider Demographics
NPI: | 1437863636 |
---|---|
Name: | NEW U PHYSICAL THERAPY PROFESSIONAL ASSOCIATION |
Entity Type: | Organization |
Organization Name: | NEW U PHYSICAL THERAPY PROFESSIONAL ASSOCIATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BORIS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | POLONSKIY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 718-502-5271 |
Mailing Address - Street 1: | 20 CRYSTAL CT |
Mailing Address - Street 2: | |
Mailing Address - City: | MANALAPAN |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07726-8881 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-502-5871 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 154 STELTON RD |
Practice Address - Street 2: | |
Practice Address - City: | PISCATAWAY |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08854-2667 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-502-5271 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-01-11 |
Last Update Date: | 2023-01-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |