Provider Demographics
NPI:1487787503
Name:INSTITUTE OF BACK TESTING & REHAB
Entity type:Organization
Organization Name:INSTITUTE OF BACK TESTING & REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VINETA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-945-2320
Mailing Address - Street 1:540 BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2802
Mailing Address - Country:US
Mailing Address - Phone:201-945-2320
Mailing Address - Fax:201-945-5007
Practice Address - Street 1:540 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2802
Practice Address - Country:US
Practice Address - Phone:201-945-2320
Practice Address - Fax:201-945-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01198400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31-6605Medicare ID - Type Unspecified