Organization Name: | PROADVANTAGE PHYSICAL THERAPY INCORPORATED |
NPI Number: | 1003064452 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | YEV FEDOSENKO (PRESIDENT) |
Mailing Address: | 300 Winston Dr Apt 2407 Cliffside Park |
State: | NJ US |
Postal Code: | 070103227 |
Phone Number: | 6176202137 |
Fax Number: | |
NPI Enumeration Date: | 08/28/2008 |
NPI Last Update Date: | 03/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 40QA01242600 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |