Provider Demographics
NPI:1295047041
Name:FLANCBAUM, PHYLLIS (PT, LNHA)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:FLANCBAUM
Suffix:
Gender:F
Credentials:PT, LNHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-20 DOROTHY ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4946
Mailing Address - Country:US
Mailing Address - Phone:201-694-3851
Mailing Address - Fax:201-794-3892
Practice Address - Street 1:100 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1828
Practice Address - Country:US
Practice Address - Phone:201-265-3700
Practice Address - Fax:201-265-2700
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NJ40QA0030972251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist