Provider Demographics
NPI:1831223122
Name:MIRVIS, SILVA KORN (PT)
Entity type:Individual
Prefix:
First Name:SILVA
Middle Name:KORN
Last Name:MIRVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 HOLLY HL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1957
Mailing Address - Country:US
Mailing Address - Phone:908-337-5809
Mailing Address - Fax:
Practice Address - Street 1:1515 LAMBERTS MILL RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-4763
Practice Address - Country:US
Practice Address - Phone:908-301-8259
Practice Address - Fax:908-232-1463
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA06871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist