Provider Demographics
NPI:1770700734
Name:ROBERT GEORGE VAN DE VEIRE, PTPA
Entity type:Organization
Organization Name:ROBERT GEORGE VAN DE VEIRE, PTPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:VAN DE VEIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-427-7838
Mailing Address - Street 1:474 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2775
Mailing Address - Country:US
Mailing Address - Phone:973-427-7838
Mailing Address - Fax:973-427-8852
Practice Address - Street 1:474 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2775
Practice Address - Country:US
Practice Address - Phone:973-437-7838
Practice Address - Fax:973-427-8852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00197500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty