Provider Demographics
NPI:1316170533
Name:RIZVI, HAIDER (DPT)
Entity type:Individual
Prefix:
First Name:HAIDER
Middle Name:
Last Name:RIZVI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 PATERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1837
Mailing Address - Country:US
Mailing Address - Phone:201-933-3040
Mailing Address - Fax:201-933-8611
Practice Address - Street 1:3830 PARK AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2562
Practice Address - Country:US
Practice Address - Phone:732-494-0895
Practice Address - Fax:732-494-0896
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01330500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01330500OtherPHYSICAL THERAPY LICENSE NUMBER