Healthcare Provider Details

I. General information

NPI: 1639475627
Provider Name (Legal Business Name): RENAISSANCE PHYSICAL THERAPY ARTS AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 VALLEY RD STE 102
MONTCLAIR NJ
07043-1522
US

IV. Provider business mailing address

734 VALLEY RD STE 102
MONTCLAIR NJ
07043-1522
US

V. Phone/Fax

Practice location:
  • Phone: 973-707-7944
  • Fax: 973-707-7541
Mailing address:
  • Phone: 973-707-7944
  • Fax: 973-707-7541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. CARYN BINDER-BREGMAN
Title or Position: PRESIDENT
Credential: P.T.
Phone: 973-707-7944