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General NPI Number Information
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NPI Number | 1275060774
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Entity Type | Organization
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Legal Business Name | WIENERPHYSICALTHERAPYSERVICES
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 05/15/2017
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Provider Practice Location Address
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Address Line | 484 LAFAYETTE AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-2522
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Country | US
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Telephone | 201-880-0952
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Fax | 201-880-4893
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Provider Business Mailing Address
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Address Line | 170 PROSPECT AVE APT 5L
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City | HACKENSACK
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State | NJ
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Zip | 07601-1858
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Country | US
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Telephone | 201-880-0952
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Fax | 201-880-4893
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | DR. PAUL NEIL WIENER
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Credential | PT, DPT
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Telephone | 201-937-8336
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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 | 40QA03741
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License Number State | NJ
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