Healthcare Provider Details

I. General information

NPI: 1235787490
Provider Name (Legal Business Name): RICHIE KUMAR PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 HACKENSACK AVE
HACKENSACK NJ
07601-6319
US

IV. Provider business mailing address

900 ROUTE 9 N FL 4
WOODBRIDGE NJ
07095-1025
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-5930
  • Fax:
Mailing address:
  • Phone: 201-801-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01881400
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: