Basic Information
| Provider Information | |||||||||
| NPI: | 1922421700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUZMANOVSKI | ||||||||
| FirstName: | NIKOLA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 582 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | NUTLEY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071101253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735420222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 112 BLOOMFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070065336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732262434 | ||||||||
| FaxNumber: | 9732263010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2014 | ||||||||
| LastUpdateDate: | 12/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/26/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 40QA01375100 | NJ | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 225100000X | 40QA01375100 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.