Basic Information
Provider Information
NPI: 1881839603
EntityType: 2
ReplacementNPI:  
OrganizationName: NORTHERN HILLS PHYSICAL THERAPY, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 272 ROUTE 206
Address2: SUITE 210
City: FLANDERS
State: NJ
PostalCode: 078369081
CountryCode: US
TelephoneNumber: 9739273034
FaxNumber: 9739272853
Practice Location
Address1: 272 ROUTE 206
Address2: SUITE 210
City: FLANDERS
State: NJ
PostalCode: 078369081
CountryCode: US
TelephoneNumber: 9739273034
FaxNumber: 9739272853
Other Information
ProviderEnumerationDate: 12/08/2008
LastUpdateDate: 12/08/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DECARO
AuthorizedOfficialFirstName: EILEEN
AuthorizedOfficialMiddleName: CHRISTINE
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 9739454160
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DPT
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QP2000X40QA01253300NJY Ambulatory Health Care FacilitiesClinic/CenterPhysical Therapy

No ID Information.


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