MEDICARE: JEEVAN THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	40QA01478100	NJ

General Provider Information

NPI Number	:	1194195271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEEVAN THERAPY

Provider Business Mailing Address
First Line	:	500 ORANGE ST
Second Line	:	SUITE 2
City	:	NEWARK
State	:	NJ
Zip	:	07107-2944
Country	:	US
Telephone Number	:	845-596-9031
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 ORANGE ST
Second Line	:	SUITE 2
City	:	NEWARK
State	:	NJ
Zip	:	07107-2944
Country	:	US
Telephone Number	:	845-596-9031
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEEVAN M MATHEW
Credential	:	PT
Telephone Number	:	845-596-9031

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	10/01/2015

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Directions to “JEEVAN THERAPY ” Practice Location

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