Provider Demographics
NPI:1750861365
Name:HERRICK HOME CARE PHYSICAL THERAPY ORTHOPEDIC & PEDIATRIC SERVICES PC
Entity Type:Organization
Organization Name:HERRICK HOME CARE PHYSICAL THERAPY ORTHOPEDIC & PEDIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:973-800-4050
Mailing Address - Street 1:2282 HAMBURG TPKE STE A
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6291
Mailing Address - Country:US
Mailing Address - Phone:973-800-4050
Mailing Address - Fax:862-330-3186
Practice Address - Street 1:2282 HAMBURG TPKE STE A
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6291
Practice Address - Country:US
Practice Address - Phone:973-800-4050
Practice Address - Fax:862-330-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA015620002251X0800X
NJ41YS00937900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty