=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700043841
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH JERSEY REHABILITATION CENTER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2008
-----------------------------------------------------
Last Update Date | 05/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 VAN NOSTRAND AVE 1ST FL
-----------------------------------------------------
City | ENGLEWOOD CLIFFS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-944-5999
-----------------------------------------------------
Fax | 201-947-3994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 VAN NOSTRAND AVE 1ST FL
-----------------------------------------------------
City | ENGLEWOOD CLIFFS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-944-5999
-----------------------------------------------------
Fax | 201-947-3994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KYUNG P YU
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 201-944-5999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 4DQA01076000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | MC05070
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------