Healthcare Provider Details

I. General information

NPI: 1790440766
Provider Name (Legal Business Name): WVA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 PERRY ST
NEW YORK NY
10014-6241
US

IV. Provider business mailing address

1521 IRVING ST
RAHWAY NJ
07065-4035
US

V. Phone/Fax

Practice location:
  • Phone: 848-467-0383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: OSARUMEN IGBINOSUN
Title or Position: OWNER
Credential: DPT
Phone: 848-467-0383