Provider Demographics
NPI:1730258757
Name:KORENSTEIN, TERESA GRACE (MSPT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:GRACE
Last Name:KORENSTEIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:SANTANIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4409
Mailing Address - Country:US
Mailing Address - Phone:201-694-7738
Mailing Address - Fax:
Practice Address - Street 1:16 WILLOWBROOK DR
Practice Address - Street 2:
Practice Address - City:NORTH CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-4409
Practice Address - Country:US
Practice Address - Phone:201-694-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01137300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091625M53Medicare ID - Type Unspecified