MEDICARE: STRIDE HOME HEALTH

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

General Provider Information

NPI Number	:	1659987246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRIDE HOME HEALTH

Provider Business Mailing Address
First Line	:	180 FOREST AVE APT 206
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-2377
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 FOREST AVE APT 206
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-2377
Country	:	US
Telephone Number	:	347-229-5996
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH GENDY
Credential	:	DPT
Telephone Number	:	347-229-5996

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	09/18/2020

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Directions to “STRIDE HOME HEALTH ” Practice Location

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