Healthcare Provider Details

I. General information

NPI: 1255595559
Provider Name (Legal Business Name): EMERSON PHYSICAL THERAPY AND REHABILITATION, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 GLENWOOD AVE
TEANECK NJ
07666-6405
US

IV. Provider business mailing address

453 GLENWOOD AVE
TEANECK NJ
07666-6405
US

V. Phone/Fax

Practice location:
  • Phone: 201-266-0414
  • Fax: 201-266-0414
Mailing address:
  • Phone: 201-266-0414
  • Fax: 201-266-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number24900-1
License Number StateNY

VIII. Authorized Official

Name: EMERSON M MATEO
Title or Position: PRESIDENT/ OWNER
Credential: PT
Phone: 201-478-0394