Provider Demographics
NPI:1831248814
Name:PHYSICAL THERAPY HOUSE CALLS LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:PHYSICAL THERAPY HOUSE CALLS LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SVETNIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-740-0389
Mailing Address - Street 1:34 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2757
Mailing Address - Country:US
Mailing Address - Phone:973-740-0389
Mailing Address - Fax:
Practice Address - Street 1:34 HARVEST LN
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2757
Practice Address - Country:US
Practice Address - Phone:973-740-0389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110130Medicare PIN