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General NPI Number Information
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NPI Number | 1427266949
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Entity Type | Organization
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Legal Business Name | INFINITY REHABILITATION AND SPORTS MEDICINE LLC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 19 W PASSAIC ST
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3213
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Country | US
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Telephone | 201-845-8002
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Fax | 201-845-8088
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Provider Business Mailing Address
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Address Line | 19 W PASSAIC ST
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3213
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Country | US
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Telephone | 201-845-8002
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Fax | 201-845-8088
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Authorized Official
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Title or Position | OWNER
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Name | DR. VINCENT MICHAEL BURKE
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Credential | PT, DPT
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Telephone | 201-845-8002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | QA00831300
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License Number State | NJ
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