Provider Demographics
NPI:1063045649
Name:PROMED PHYSICAL THERAPY CORP.
Entity type:Organization
Organization Name:PROMED PHYSICAL THERAPY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-779-4998
Mailing Address - Street 1:321 54TH ST APT 302
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2278
Mailing Address - Country:US
Mailing Address - Phone:201-779-4998
Mailing Address - Fax:
Practice Address - Street 1:40 N VAN BRUNT ST STE 29
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2716
Practice Address - Country:US
Practice Address - Phone:201-779-4998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty