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General NPI Number Information
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NPI Number | 1104189265
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Entity Type | Organization
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Legal Business Name | QUEENS EARLY INTERVENTION PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 4 LOHMANN PL
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City | DUMONT
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State | NJ
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Zip | 07628-1521
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Country | US
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Telephone | 347-724-0141
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Fax |
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Provider Business Mailing Address
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Address Line | 4 LOHMANN PL
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City | DUMONT
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State | NJ
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Zip | 07628-1521
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Country | US
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Telephone | 347-724-0141
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL SHOYINKA
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Credential | DPT
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Telephone | 347-724-0141
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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 | 023941
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License Number State | NY
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