Healthcare Provider Details

I. General information

NPI: 1629096292
Provider Name (Legal Business Name): NORTHERN VALLEY PHYSICAL THERAPY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 WESTWOOD AVE STE 100
RIVER VALE NJ
07675-5300
US

IV. Provider business mailing address

645 WESTWOOD AVE STE 100
RIVER VALE NJ
07675-5300
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-9100
  • Fax: 201-666-9102
Mailing address:
  • Phone: 201-666-9100
  • Fax: 201-666-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA00226900
License Number StateNJ

VIII. Authorized Official

Name: MS. DENISE KEEHN
Title or Position: DIRECTOR
Credential: PT, DPT
Phone: 201-666-9100