Healthcare Provider Details

I. General information

NPI: 1235545260
Provider Name (Legal Business Name): SPRING VALLEY ORTHOPEDIC AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SPRING VALLEY AVE
HACKENSACK NJ
07601-3801
US

IV. Provider business mailing address

6 SPRING VALLEY AVE
HACKENSACK NJ
07601-3801
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-9555
  • Fax: 201-489-9569
Mailing address:
  • Phone: 201-489-9555
  • Fax: 201-489-9569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA07819000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA06309600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01525400
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00541200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHANNA ANDREA ESTRADA
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-489-9555