Provider Demographics
NPI:1184803017
Name:I&M PHYSICAL THERAPY, P.C
Entity type:Organization
Organization Name:I&M PHYSICAL THERAPY, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLOSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-614-6191
Mailing Address - Street 1:16 VALLEY FORGE LN
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3416
Mailing Address - Country:US
Mailing Address - Phone:718-614-6191
Mailing Address - Fax:
Practice Address - Street 1:41 CENTER ST STE 3
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2220
Practice Address - Country:US
Practice Address - Phone:732-333-0062
Practice Address - Fax:732-333-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-27
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01268300261QP2000X
NJ40QA01188300261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ120599Medicare PIN