Provider Demographics
NPI: | 1760916340 |
---|---|
Name: | SENSORY TAEKWONDO OF WALDWICK |
Entity Type: | Organization |
Organization Name: | SENSORY TAEKWONDO OF WALDWICK |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ZOWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | KERRY |
Authorized Official - Middle Name: | JOSEPH |
Authorized Official - Last Name: | ESCAMILLA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 201-895-1496 |
Mailing Address - Street 1: | 140 HOPPER AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | WALDWICK |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07463 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 201-399-4124 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 140 HOPPER AVE |
Practice Address - Street 2: | |
Practice Address - City: | WALDWICK |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07463 |
Practice Address - Country: | US |
Practice Address - Phone: | 201-399-4124 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-04-20 |
Last Update Date: | 2017-04-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 106E00000X | Behavioral Health & Social Service Providers | Assistant Behavior Analyst | Group - Multi-Specialty | |
No | 221700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist | Group - Multi-Specialty | |
No | 225A00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |