Provider Demographics
NPI:1639475627
Name:RENAISSANCE PHYSICAL THERAPY ARTS AND WELLNESS
Entity Type:Organization
Organization Name:RENAISSANCE PHYSICAL THERAPY ARTS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BINDER-BREGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-707-7944
Mailing Address - Street 1:734 VALLEY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1522
Mailing Address - Country:US
Mailing Address - Phone:973-707-7944
Mailing Address - Fax:973-707-7541
Practice Address - Street 1:734 VALLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1522
Practice Address - Country:US
Practice Address - Phone:973-707-7944
Practice Address - Fax:973-707-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty