Provider Demographics
NPI:1972546190
Name:KAVALERCHIK, BELLA (PT)
Entity type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:KAVALERCHIK
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 1:1 GROVER TER
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4506
Mailing Address - Country:US
Mailing Address - Phone:201-791-7177
Mailing Address - Fax:
Practice Address - Street 1:218 ROUTE 17 NORTH STE 304
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3399
Practice Address - Country:US
Practice Address - Phone:201-791-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00776000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
077026TMSMedicare ID - Type Unspecified