Provider Demographics
NPI:1811042070
Name:AJL PHYSICAL & OCCUPATIONAL THERAPY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:AJL PHYSICAL & OCCUPATIONAL THERAPY ASSOCIATES, P.A.
Other - Org Name:AJL PHYSICAL & OCCUPATIONAL THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAYKISH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-226-1655
Mailing Address - Street 1:7 ROSEMERE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6512
Mailing Address - Country:US
Mailing Address - Phone:973-226-1655
Mailing Address - Fax:973-226-4502
Practice Address - Street 1:204 EAGLE ROCK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1723
Practice Address - Country:US
Practice Address - Phone:973-226-1655
Practice Address - Fax:973-226-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050105Medicare ID - Type Unspecified