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General NPI Number Information
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NPI Number | 1710361209
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Entity Type | Individual
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Provider Name | ROBERTA BORNSTEIN PT - PEDIATRIC PHYSI
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Gender | Female
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 120 COUNTY ROAD SUITE 101
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City | TENAFLY
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State | NJ
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Zip | 07670
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Country | US
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Telephone | 201-894-5800
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Fax | 201-894-5990
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Provider Business Mailing Address
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Address Line | 120 COUNTY ROAD SUITE 101
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City | TENAFLY
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State | NJ
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Zip | 07670
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Country | US
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Telephone | 201-894-5800
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Fax | 201-894-5990
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 40QA00345900
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License Number State | NJ
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