Provider Demographics
NPI:1629096292
Name:NORTHERN VALLEY PHYSICAL THERAPY PA
Entity Type:Organization
Organization Name:NORTHERN VALLEY PHYSICAL THERAPY PA
Other - Org Name:RIVER VALE PHYSICAL THERAPY, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEHN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:201-666-9100
Mailing Address - Street 1:645 WESTWOOD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-5300
Mailing Address - Country:US
Mailing Address - Phone:201-666-9100
Mailing Address - Fax:201-666-9102
Practice Address - Street 1:645 WESTWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:RIVER VALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-5300
Practice Address - Country:US
Practice Address - Phone:201-666-9100
Practice Address - Fax:201-666-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00226900261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6496800001Medicare NSC
NJ102614Medicare PIN