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General NPI Number Information
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NPI Number | 1013302447
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Entity Type | Organization
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Legal Business Name | GENUINE REHABILITATION INC
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 170 OAK STREET
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City | RIDGEWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 201-925-0056
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Fax |
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Provider Business Mailing Address
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Address Line | 170 OAK STREET
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City | RIDGEWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 201-925-0056
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLGA CHAIKOVSKY
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Credential | PT MS
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Telephone | 201-925-0056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00932000
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License Number State | NJ
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