Healthcare Provider Details

I. General information

NPI: 1851445068
Provider Name (Legal Business Name): MAHWAH HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
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 STE 9
MAHWAH NJ
07430-1364
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 Number40QA007693
License Number StateNJ

VIII. Authorized Official

Name: MR. RICH CRAIG EDELSON
Title or Position: OWNER
Credential:
Phone: 201-828-9290