Provider Demographics
NPI:1902836240
Name:PILLAR OF LIGHT, INC
Entity Type:Organization
Organization Name:PILLAR OF LIGHT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSHTROM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-797-8028
Mailing Address - Street 1:37-03 BERDAN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4229
Mailing Address - Country:US
Mailing Address - Phone:201-797-8028
Mailing Address - Fax:201-797-2676
Practice Address - Street 1:37-03 BERDAN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4229
Practice Address - Country:US
Practice Address - Phone:201-797-8028
Practice Address - Fax:201-797-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00379900261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ062219Medicare ID - Type Unspecified