Provider Demographics
NPI:1790919249
Name:CHUDNOFF, RIVKA TALIA (MS,PT)
Entity Type:Individual
Prefix:MS
First Name:RIVKA
Middle Name:TALIA
Last Name:CHUDNOFF
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHGATE TER
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3922
Mailing Address - Country:US
Mailing Address - Phone:732-580-8904
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHGATE TER
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3922
Practice Address - Country:US
Practice Address - Phone:732-580-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01262800225100000X
NY021129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist