Healthcare Provider Details

I. General information

NPI: 1881826402
Provider Name (Legal Business Name): VIGOR PHYSICAL THERAPY AND REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2009
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MCBRIDE AVE STE 203
WOODLAND PARK NJ
07424-3813
US

IV. Provider business mailing address

1225 MCBRIDE AVE STE 203
WOODLAND PARK NJ
07424-3813
US

V. Phone/Fax

Practice location:
  • Phone: 973-339-9902
  • Fax: 973-339-9903
Mailing address:
  • Phone: 973-339-9902
  • Fax: 973-339-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01188300
License Number StateNJ

VIII. Authorized Official

Name: DR. IGOR VOLOSHIN
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 718-614-6191