Provider Demographics
NPI:1124127212
Name:KAYNAK, THOMAS J (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:KAYNAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:161 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1825
Mailing Address - Country:US
Mailing Address - Phone:973-376-7100
Mailing Address - Fax:973-376-7101
Practice Address - Street 1:449 MARKET ST
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5941
Practice Address - Country:US
Practice Address - Phone:201-712-5533
Practice Address - Fax:201-712-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00617200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist