Provider Demographics
NPI:1598011207
Name:HEALING STAR PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:HEALING STAR PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT (CO-OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:VARGHESE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:848-208-2721
Mailing Address - Street 1:145 WYCKOFF RD SUITE 102
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724
Mailing Address - Country:US
Mailing Address - Phone:848-208-2721
Mailing Address - Fax:848-208-2506
Practice Address - Street 1:145 WYCKOFF RD SUITE 102
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724
Practice Address - Country:US
Practice Address - Phone:848-208-2721
Practice Address - Fax:848-208-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01145500PT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1598011207Medicare NSC