EVERGREEN MEDICAL GROUP PC
NPI 1295516409
Physical Medicine & Rehabilitation in River Edge, NJ
NPI Status: Active since October 12, 2023
Contact Information
887 KINDERKAMACK RD STE 2
RIVER EDGE, NJ
ZIP 07661
Phone: (201) 464-0860
Fax: (888) 440-2752
- Organization
- Physical Medicine & Rehabilitation
- CLIA Number: 31D2321162
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 03-30-2027
About EVERGREEN MEDICAL GROUP PC
This page provides the complete NPI Profile along with additional information for Evergreen Medical Group Pc, a provider established in River Edge, New Jersey operating as a Physical Medicine & Rehabilitation. The healthcare provider is registered in the NPI registry with number 1295516409 assigned on October 2023. The practitioner's primary taxonomy code is 208100000X. The provider is registered as an organization and their NPI record was last updated one year ago. Evergreen Medical Group Pc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Grigory Shtender Md (Owner)
- NPI
- 1295516409
- Provider Name
- EVERGREEN MEDICAL GROUP PC
- Entity Type
- Organization
- Location Address
- 887 KINDERKAMACK RD STE 2 RIVER EDGE, NJ 07661
- Location Phone
- (201) 464-0860
- Location Fax
- (888) 440-2752
- Mailing Address
- 887 KINDERKAMACK RD STE 2 RIVER EDGE, NJ 07661
- Mailing Phone
- (201) 464-0860
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-12-2023
- Last Update Date
- 02-11-2025
- Code Navigator
Location Map
Secondary Locations
- 31-00 Broadway
Fair Lawn, NJ 07410
(201) 791-7771
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Physical Medicine & Rehabilitation
- Taxonomy Code
- 208100000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. These disabilities may arise from conditions affecting the musculoskeletal system such as neck and back pain, sports injuries, or other painful conditions affecting the limbs, such as carpal tunnel syndrome. Alternatively, the disabilities may result from neurological trauma or disease such as spinal cord injury, head injury or stroke. A physician certified in physical medicine and rehabilitation is often called a physiatrist. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation. Pain management is often an important part of the role of the physiatrist. For diagnosis and evaluation, a physiatrist may include the techniques of electromyography to supplement the standard history, physical, x-ray and laboratory examinations. The physiatrist has expertise in the appropriate use of therapeutic exercise, prosthetics (artificial limbs), orthotics and mechanical and electrical devices.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 111N00000X | Chiropractic Providers | Chiropractor | |
| 2 | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
| 3 | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | |
| 4 | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | |
| 5 | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
| 6 | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
| 7 | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
| 8 | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
| 9 | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 31D2321162
- Facility Type
- Physician Office
- Certificate Effective Date
- March 31, 2025
- Certificate Expiration Date
- March 30, 2027
- Laboratory Director
- VASYL PIDKAMINETSKIY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Evergreen Medical Group Pc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1295516409, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 51. The final step is to find the difference between that total and the next multiple of ten (60 - 51 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 51 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1295516409, enumerated as an "organization" on October 12, 2023.
The provider is located at 887 KINDERKAMACK RD STE 2 RIVER EDGE, NJ 07661 and the phone number is (201) 464-0860.
Physical Medicine & Rehabilitation with taxonomy code 208100000X.
