Provider Demographics
NPI:1487011672
Name:KINETIC PHYSICAL THERAPY OF HACKENSACK, PA
Entity Type:Organization
Organization Name:KINETIC PHYSICAL THERAPY OF HACKENSACK, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAIT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-327-1990
Mailing Address - Street 1:171 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2089
Mailing Address - Country:US
Mailing Address - Phone:201-327-1990
Mailing Address - Fax:201-327-1921
Practice Address - Street 1:182 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1331
Practice Address - Country:US
Practice Address - Phone:201-573-0066
Practice Address - Fax:201-573-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty