Basic Information
| Provider Information | |||||||||
| NPI: | 1689742025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHURCHILL | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | KNOWLES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 OAKDENE AVENUE | ||||||||
| Address2: | |||||||||
| City: | LEONIA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076052039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019474862 | ||||||||
| FaxNumber: | 2018331390 | ||||||||
| Practice Location | |||||||||
| Address1: | 1086 TEANECK RD | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018331333 | ||||||||
| FaxNumber: | 2018331390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QAO3114 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.