Healthcare Provider Details

I. General information

NPI: 1629488127
Provider Name (Legal Business Name): MAHWAH HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 FRANKLIN TPKE
MAHWAH NJ
07430-1339
US

IV. Provider business mailing address

195 FRANKLIN TPKE
MAHWAH NJ
07430-1339
US

V. Phone/Fax

Practice location:
  • Phone: 201-828-9290
  • Fax: 201-828-9670
Mailing address:
  • Phone: 201-828-9290
  • Fax: 201-828-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01525600
License Number StateNJ

VIII. Authorized Official

Name: MR. PAUL BALISI
Title or Position: OWNER
Credential: PT
Phone: 201-828-9290