Healthcare Provider Details

I. General information

NPI: 1164024097
Provider Name (Legal Business Name): SCHUYLER MCILVAINE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 RIDGE RD
LYNDHURST NJ
07071-3216
US

IV. Provider business mailing address

710 MILL ST
BELLEVILLE NJ
07109-5318
US

V. Phone/Fax

Practice location:
  • Phone: 201-500-9812
  • Fax:
Mailing address:
  • Phone: 973-393-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01959000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: