Provider Demographics
NPI:1619577889
Name:IKPT, LLC
Entity Type:Organization
Organization Name:IKPT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:120-175-0670
Mailing Address - Street 1:24 W RAILROAD AVE # 308
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1735
Mailing Address - Country:US
Mailing Address - Phone:201-750-6708
Mailing Address - Fax:201-750-6442
Practice Address - Street 1:8 LAUREN POND CT
Practice Address - Street 2:
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-2500
Practice Address - Country:US
Practice Address - Phone:120-168-1751
Practice Address - Fax:201-750-6442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IKPT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty