Provider Demographics
NPI:1518548437
Name:SILVER LAKE PHYSICAL THERAPY OF RANDOLPH
Entity type:Organization
Organization Name:SILVER LAKE PHYSICAL THERAPY OF RANDOLPH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:UMALI-DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-933-2224
Mailing Address - Street 1:1201 SUSSEX TPKE STE 104
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2974
Mailing Address - Country:US
Mailing Address - Phone:973-933-2224
Mailing Address - Fax:973-933-2618
Practice Address - Street 1:1201 SUSSEX TPKE STE 104
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2974
Practice Address - Country:US
Practice Address - Phone:973-933-2224
Practice Address - Fax:973-933-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty