=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881826402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIGOR PHYSICAL THERAPY AND REHABILITATION PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2009
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1225 MCBRIDE AVE STE 203
-----------------------------------------------------
City | WOODLAND PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07424-3813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-339-9902
-----------------------------------------------------
Fax | 973-339-9903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1225 MCBRIDE AVE STE 203
-----------------------------------------------------
City | WOODLAND PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07424-3813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-339-9902
-----------------------------------------------------
Fax | 973-339-9903
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF PHYSICAL THERAPY
-----------------------------------------------------
Name | DR. IGOR VOLOSHIN
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 718-614-6191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 40QA01188300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------