Healthcare Provider Details

I. General information

NPI: 1194875252
Provider Name (Legal Business Name): DANIEL SIME VIDAIC DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 FRANKLIN TPKE STE 220
WALDWICK NJ
07463-1754
US

IV. Provider business mailing address

PO BOX 260
ORADELL NJ
07649-0260
US

V. Phone/Fax

Practice location:
  • Phone: 201-885-4200
  • Fax: 201-877-4100
Mailing address:
  • Phone: 201-885-4200
  • Fax: 201-877-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00904900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: