Provider Demographics
NPI:1730852070
Name:ESSENTIAL THERAPY SERVICES OF NJ
Entity type:Organization
Organization Name:ESSENTIAL THERAPY SERVICES OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:IDOMENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-499-8496
Mailing Address - Street 1:2703 MILBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4115
Mailing Address - Country:US
Mailing Address - Phone:917-499-8496
Mailing Address - Fax:844-800-1470
Practice Address - Street 1:100 ENTERPRISE DR STE 301
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2129
Practice Address - Country:US
Practice Address - Phone:602-703-2801
Practice Address - Fax:844-800-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty