Healthcare Provider Details

I. General information

NPI: 1871916130
Provider Name (Legal Business Name): PRO STAFF DYNAMIC HAND THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CLAREMONT AVE SUITE 5
MONTCLAIR NJ
07042-4854
US

IV. Provider business mailing address

265 FRANKLIN AVE
NUTLEY NJ
07110-2712
US

V. Phone/Fax

Practice location:
  • Phone: 973-680-8390
  • Fax: 973-680-8391
Mailing address:
  • Phone: 973-680-8390
  • Fax: 973-680-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number46TR00508400
License Number StateNJ

VIII. Authorized Official

Name: MISS JACLYN ANN KOPIDLOWSKI
Title or Position: OWNER
Credential: MS, OTR/L, CHT
Phone: 973-766-3523