Healthcare Provider Details

I. General information

NPI: 1336660653
Provider Name (Legal Business Name): TOTAL HEALTH PHYSICAL MEDICINE & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 SPRINGFIELD AVE
BERKELEY HEIGHTS NJ
07922-1112
US

IV. Provider business mailing address

492 SPRINGFIELD AVE
BERKELEY HEIGHTS NJ
07922-1112
US

V. Phone/Fax

Practice location:
  • Phone: 908-665-0770
  • Fax:
Mailing address:
  • Phone: 908-665-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: TODD TYMINSKI
Title or Position: PRESIDENT
Credential:
Phone: 973-377-6327