Healthcare Provider Details

I. General information

NPI: 1669725776
Provider Name (Legal Business Name): MOTION SPORTS MEDICINE AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 SHREWSBURY AVE
TINTON FALLS NJ
07724-3006
US

IV. Provider business mailing address

776 SHREWSBURY AVE
TINTON FALLS NJ
07724-3006
US

V. Phone/Fax

Practice location:
  • Phone: 732-957-0065
  • Fax: 732-957-0717
Mailing address:
  • Phone: 732-957-0065
  • Fax: 732-957-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN HENRY HUISH
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 732-957-0065