Healthcare Provider Details

I. General information

NPI: 1972546190
Provider Name (Legal Business Name): BELLA KAVALERCHIK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 ROUTE 17 NORTH STE 304
ROCHELLE PARK NJ
07662-3399
US

IV. Provider business mailing address

1 GROVER TER
FAIR LAWN NJ
07410-4506
US

V. Phone/Fax

Practice location:
  • Phone: 201-791-0008
  • Fax:
Mailing address:
  • Phone: 201-791-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00776000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: