MEDICARE: MRS. NANCY R KIRSCH P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	QA00991	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28901	OTHER	NJ	CIGNA

General Provider Information

NPI Number	:	1003800574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY R KIRSCH P.T.

Provider Business Mailing Address
First Line	:	14 MONHEGON AVE
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-1808
Country	:	US
Telephone Number	:	973-627-4283
Fax Number	:

Provider Business Practice Location Address
First Line	:	272 ROUTE 206
Second Line	:
City	:	FLANDERS
State	:	NJ
Zip	:	07836-9081
Country	:	US
Telephone Number	:	973-927-3034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/08/2007

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