Provider Demographics
NPI:1174887889
Name:FRIENDS PM&R PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:FRIENDS PM&R PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOGINI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAVANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-412-3423
Mailing Address - Street 1:89 RIVER ST
Mailing Address - Street 2:#1606
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-9600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:89 RIVER ST
Practice Address - Street 2:#1606
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-9600
Practice Address - Country:US
Practice Address - Phone:917-412-3423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08207400208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11731Medicare PIN