Provider Demographics
NPI:1700011814
Name:E.A.S. PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:E.A.S. PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HYEO YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:201-313-4840
Mailing Address - Street 1:21 GRAND AVE
Mailing Address - Street 2:SOUTH BUILDING #504
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650
Mailing Address - Country:US
Mailing Address - Phone:201-941-8990
Mailing Address - Fax:201-941-0991
Practice Address - Street 1:21 GRAND AVE
Practice Address - Street 2:SOUTH BUILDING #504
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1076
Practice Address - Country:US
Practice Address - Phone:201-941-8990
Practice Address - Fax:201-941-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00899500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1598953341Medicare NSC