Provider Demographics
NPI:1558383661
Name:IN REHABILITATION AND WELLNESS PC
Entity Type:Organization
Organization Name:IN REHABILITATION AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAEGYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-894-5451
Mailing Address - Street 1:464 HUDSON TER
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2902
Mailing Address - Country:US
Mailing Address - Phone:201-894-5451
Mailing Address - Fax:201-894-5450
Practice Address - Street 1:464 HUDSON TER
Practice Address - Street 2:SUITE 204
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2917
Practice Address - Country:US
Practice Address - Phone:201-894-5451
Practice Address - Fax:201-894-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01140100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ105163Medicare PIN