Provider Demographics
NPI:1902249246
Name:PUSH TO WALK
Entity Type:Organization
Organization Name:PUSH TO WALK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-200-5848
Mailing Address - Street 1:6 N CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1715
Mailing Address - Country:US
Mailing Address - Phone:862-200-5848
Mailing Address - Fax:862-200-5976
Practice Address - Street 1:6 N CORPORATE DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1715
Practice Address - Country:US
Practice Address - Phone:862-200-5848
Practice Address - Fax:862-200-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation