Provider Demographics
NPI:1245545847
Name:CHEN, DVIR (PT)
Entity type:Individual
Prefix:
First Name:DVIR
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MCBRIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2534
Mailing Address - Country:US
Mailing Address - Phone:973-237-3275
Mailing Address - Fax:973-237-1272
Practice Address - Street 1:1025 MCBRIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2534
Practice Address - Country:US
Practice Address - Phone:973-237-3275
Practice Address - Fax:973-237-1272
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01361800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist