Healthcare Provider Details

I. General information

NPI: 1598882524
Provider Name (Legal Business Name): FAIR LAWN PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14-25 PLAZA RD SUITE S-2-4
FAIR LAWN NJ
07410-3546
US

IV. Provider business mailing address

14-25 PLAZA RD SUITE S-2-4
FAIR LAWN NJ
07410-3546
US

V. Phone/Fax

Practice location:
  • Phone: 201-797-7373
  • Fax:
Mailing address:
  • Phone: 201-797-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT KHALAF
Title or Position: DIRECTOR
Credential: D.C.
Phone: 201-797-7373