Basic Information
Provider Information
NPI: 1003800574
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIRSCH
FirstName: NANCY
MiddleName: R
NamePrefix: MRS.
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14 MONHEGON AVE
Address2:  
City: ROCKAWAY
State: NJ
PostalCode: 078661808
CountryCode: US
TelephoneNumber: 9736274283
FaxNumber:  
Practice Location
Address1: 272 ROUTE 206
Address2:  
City: FLANDERS
State: NJ
PostalCode: 078369081
CountryCode: US
TelephoneNumber: 9739273034
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/09/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XQA00991NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
2890101NJCIGNAOTHER


Home