Provider Demographics
NPI:1962684225
Name:CORE DYNAMICS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:CORE DYNAMICS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIVA
Authorized Official - Middle Name:ELLA
Authorized Official - Last Name:HERZIG
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:201-568-5060
Mailing Address - Street 1:177 N DEAN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2533
Mailing Address - Country:US
Mailing Address - Phone:201-568-5060
Mailing Address - Fax:201-568-5061
Practice Address - Street 1:177 N DEAN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2533
Practice Address - Country:US
Practice Address - Phone:201-568-5060
Practice Address - Fax:201-568-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ119401Medicare PIN