Provider Demographics
NPI:1508243981
Name:PEDIATRIC THERAPY & YOGA OF MORRIS
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY & YOGA OF MORRIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-998-8700
Mailing Address - Street 1:18 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-8100
Mailing Address - Country:US
Mailing Address - Phone:973-998-8700
Mailing Address - Fax:
Practice Address - Street 1:18 ELM ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-8100
Practice Address - Country:US
Practice Address - Phone:973-998-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00144100261QD1600X
261QH0700X
NJ40QA00795300261QP2000X
NJ46TR00426800261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1548676588Medicaid