Kodiak Healthcare Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

KODIAK HEALTHCARE INC

Doing business as

TU Rehab

Practice address

670 N Beers St Ste 110
Holmdel, NJ 07733-1547

Phone

(732) 203-0104

NPI assigned

Nov 14, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dov IwaniskiNPI 1164726394

Title

President

Phone

(718) 986-1820

Specialties & licenses 1

Addresses

Other names 1

• TU Rehab Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dov Iwaniski, DPT

  • Physical Therapist
  • Lakewood, NJ
  • NPI 1164726394
  Medicare reassignment NPD Authorized official
• Fady Abdelfady Youssef, DPT

  • Physical Therapist
  • Parsippany, NJ
  • NPI 1912476193
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573689600000",
    "number": "1215572185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 N BEERS ST STE 110",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 N BEERS ST STE 110",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331547",
            "telephone_number": "732-203-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KODIAK HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-14",
        "last_updated": "2019-11-14",
        "status": "A",
        "authorized_official_last_name": "IWANISKI",
        "authorized_official_first_name": "DOV",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-986-1820"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TU Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lauren Kimble, LAC
• Lindsey Kirdahy
• Daria Klemick
• Kathleen Knauf, ATC
• Knok Management
• Kodiak Physical Therapy LLC (Kodiak Physical Therapy)
• Sowmini Kommireddi
• Kotiyark Inc (Bayshore Homecare Pharmacy)
• Kotiyark Inc (Bayshore Homecare LTC Pharmacy)
• Catherine Patricia Kowalski, D.C.

• Physical Therapist in Holmdel, NJ
• Providers in Holmdel, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.