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General NPI Number Information
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NPI Number | 1780452060
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Entity Type | Organization
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Legal Business Name | EVENING STAR REHABILITATION PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 12/15/2023
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 334 SAINT PAULS AVE APT 2
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City | JERSEY CITY
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State | NJ
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Zip | 07306-5019
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Country | US
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Telephone | 201-716-9140
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Fax |
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Provider Business Mailing Address
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Address Line | 334 SAINT PAULS AVE APT 2
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City | JERSEY CITY
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State | NJ
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Zip | 07306-5019
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Country | US
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Telephone | 201-716-9140
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NISHITKUMAR KAUSHIK
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Credential |
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Telephone | 201-716-9140
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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 |
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License Number State |
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