Basic Information
| Provider Information | |||||||||
| NPI: | 1235513987 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KIPNIS PHYSICAL THERAPY AND SPORTS MEDICINE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KIPNIS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 SUSSEX ST APT 3 | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073024415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015729306 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 FLANAGAN WAY | ||||||||
| Address2: | |||||||||
| City: | SECAUCUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070943445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013190010 | ||||||||
| FaxNumber: | 2013193389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2015 | ||||||||
| LastUpdateDate: | 07/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | STRANG | ||||||||
| AuthorizedOfficialFirstName: | SEAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2013190010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 40QA01389100 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.