=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447640487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELLEN STOLOFF PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2015
-----------------------------------------------------
Last Update Date | 02/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 907 KENSINGTON LN
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-8252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-270-4661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 907 KENSINGTON LN
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-8252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELLEN STOLOFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-270-4661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physical Therapist
-----------------------------------------------------
License Number | 40QA01579700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251G0304X
-----------------------------------------------------
Taxonomy Name | Geriatric Physical Therapist
-----------------------------------------------------
License Number | 40QA01579700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------