Healthcare Provider Details

I. General information

NPI: 1023822244
Provider Name (Legal Business Name): HERSTEL THERAPIE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 BRADLEY AVE
STATEN ISLAND NY
10314-5166
US

IV. Provider business mailing address

48 RESERVOIR RD
HACKETTSTOWN NJ
07840-5647
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-8800
  • Fax:
Mailing address:
  • Phone: 718-909-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EBENEZER A AWOLESI
Title or Position: OWNER
Credential:
Phone: 718-909-4660