Provider Demographics
NPI:1508912635
Name:IRVINGTON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:IRVINGTON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-375-5400
Mailing Address - Street 1:50 UNION AVE
Mailing Address - Street 2:501
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3262
Mailing Address - Country:US
Mailing Address - Phone:973-375-5400
Mailing Address - Fax:973-375-5792
Practice Address - Street 1:50 UNION AVE
Practice Address - Street 2:501
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3262
Practice Address - Country:US
Practice Address - Phone:973-375-5400
Practice Address - Fax:973-375-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01043900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty