Provider Demographics
NPI:1710361209
Name:BORNSTEIN, ROBERTA (PT - PEDIATRIC PHYSI)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:PT - PEDIATRIC PHYSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 COUNTY ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670
Mailing Address - Country:US
Mailing Address - Phone:201-894-5800
Mailing Address - Fax:201-894-5990
Practice Address - Street 1:120 COUNTY ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670
Practice Address - Country:US
Practice Address - Phone:201-894-5800
Practice Address - Fax:201-894-5990
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA003459002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics