Healthcare Provider Details

I. General information

NPI: 1780452060
Provider Name (Legal Business Name): EVENING STAR REHABILITATION PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 SAINT PAULS AVE APT 2
JERSEY CITY NJ
07306-5019
US

IV. Provider business mailing address

334 SAINT PAULS AVE APT 2
JERSEY CITY NJ
07306-5019
US

V. Phone/Fax

Practice location:
  • Phone: 201-716-9140
  • Fax:
Mailing address:
  • Phone: 201-716-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: NISHITKUMAR KAUSHIK
Title or Position: OWNER
Credential:
Phone: 201-716-9140