Provider Demographics
NPI:1629898986
Name:BOSCO PARK PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BOSCO PARK PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEONGYEOL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:201-566-6398
Mailing Address - Street 1:440 SYLVAN AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2736
Mailing Address - Country:US
Mailing Address - Phone:201-566-6398
Mailing Address - Fax:201-367-3482
Practice Address - Street 1:440 SYLVAN AVE STE 135
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2736
Practice Address - Country:US
Practice Address - Phone:201-937-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy