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General NPI Number Information
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NPI Number | 1124066626
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Entity Type | Organization
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Legal Business Name | ASCLEPION PHYSICAL THERAPY & WELLNESS LLC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 09/09/2007
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Provider Practice Location Address
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Address Line | 22 OLD SHORT HILLS RD SUITE 102
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5604
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Country | US
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Telephone | 973-994-6535
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Fax | 973-994-6536
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Provider Business Mailing Address
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Address Line | 22 OLD SHORT HILLS RD SUITE 102
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5604
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Country | US
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Telephone | 973-994-6535
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VLADIMIR STASHCHYSHYN
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Credential | MSPT
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Telephone | 973-994-6535
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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 | 40QA01004600
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License Number State | NJ
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