Provider Demographics
NPI:1629429642
Name:TEANECK ORTHOPAEDIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TEANECK ORTHOPAEDIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:SAMILLANO
Authorized Official - Last Name:MALALUAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-357-5421
Mailing Address - Street 1:1182 TEANECK RD
Mailing Address - Street 2:STE 101
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4824
Mailing Address - Country:US
Mailing Address - Phone:201-357-5421
Mailing Address - Fax:201-357-5422
Practice Address - Street 1:1182 TEANECK RD
Practice Address - Street 2:STE 101
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4824
Practice Address - Country:US
Practice Address - Phone:201-357-5421
Practice Address - Fax:201-357-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QAO1144000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy